Determinants of androgen deprivation therapy use for prostate cancer: role of urologist

Androgen deprivation therapy, which blocks steroid hormones called androgens, is used in around 50% of prostate cancer patients. It is recommended for locally advanced and metastatic prostate cancer. Because the therapy is expensive and potentially toxic, it is important to understand the factors responsible for its use.

Vahakn B. Shahinian, from the University of Texas Medical Branch in Galveston, and colleagues analyzed data from 61,717 men in the Surveillance, Epidemiology, and End Results ( SEER ) -- Medicare database who were diagnosed with prostate cancer at age 65 years or older and from their 1,802 urologists.
The researchers assessed the pattern of androgen therapy use within 6 months of diagnosis to determine the part attributable to the urologist versus patient and tumor characteristics.

The authors found that the use of androgen deprivation therapy for prostate cancer was more dependent on the urologist who treated the patient than characteristics of the tumor or patient. They report that 21% of variance in the use of androgen deprivation therapy could be attributed to the urologist, versus 9.7% to tumor characteristics ( stage or grade ), and 4.3% to patient characteristics.

The authors write, " The substantial variance in use of androgen deprivation therapy attributable to the urologist, independent of patient factors, suggest that interventions at the level of the urologist may be an effective way to modify the use of this therapy for prostate cancer."

In an accompanying editorial, Paul F. Schellhammer, of Eastern Virginia Medical School in Norfolk, discusses the challenges of using androgen deprivation for prostate cancer therapy. He writes, " The challenge for urologists is to offer men with high-risk, potentially lethal prostate cancer androgen deprivation therapy early in their course of treatment and to avoid the unnecessary risks of androgen deprivation therapy among men with low-risk indolent disease."

Source: Journal of the National Cancer Institute, 2006


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