Real-World Practice Patterns and Predictors of Continuous versus Intermittent Androgen Deprivation Therapy Use for Prostate Cancer in Older Men

Abstract

Study Need and Importance: Despite Phase III randomized controlled trial evidence suggesting that intermittent (I) androgen deprivation therapy (ADT) is not significantly inferior to continuous ADT for prostate cancer (PC), guideline adoption and real-world clinical practice vary widely. IADT is likely underutilized, resulting in a substantial and avoidable quality of life impairment, morbidity, and cost. Furthermore, this research provides insight into opportunities to standardize care for newer androgen-receptor-axis-targeted agents that now occupy a similar patient population and prescriber practice. What We Found: We describe the utilization rates, practice patterns, and predictors of IADT in PC patients over age 65 on ADT at the population level in Ontario, Canada. Amongst all patients, 16.4% (1,404/8,544) received IADT. This ranged from 11.4%e24.8% across health-planning regions, and increased to 26.6% (457/1,715) in those with previous local therapy. Mean followup was 8.3 years.Patients with prior local therapy (OR 1.85 [95% confidence interval 1.59e2.17], p<0.001) and those 0022-5347/21/2064-0933/0 THE JOURNAL OF UROLOGY ®

Comparison of Intermittent and Continuous Androgen Deprivation Therapy in Prostate Cancer Patients: An Up-to-Date Meta-analysis for Urologists and Medical Providers

“…In a 2021 review, the authors claim that iADT is being underutilized, with only 1 in 4 to 1 in 6 eligible patients receiving it. 30 Yet guidelines published by the National Comprehensive Cancer Network, the AUA, and the National Cancer Institute all recommend cADT for reasons such as inconclusive evidence favoring iADT. 2,4,5 Therefore, the main purpose of this meta-analysis is to provide an update on these 2 ADT treatment forms for practicing urologists and clinicians based on the evidence of recent clinical trials regarding the main variables of PCa-specific mortality and non-PCa mortality.…”

This Month in Adult Urology

“…In this study, Cheung et al (page 933) from Canada studied use of IADT in men in Ontario, Canada. 5 Only 16% of patients potentially eligible for IADT received it. Radiation oncologists and physicians with more than 10 years of experience were more likely to use IADT.…”