417 MEDICATION USE BEFORE AND AFTER TREATMENT OF NEWLY DIAGNOSED PROSTATE CANCER

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness III1 Apr 2012417 MEDICATION USE BEFORE AND AFTER TREATMENT OF NEWLY DIAGNOSED PROSTATE CANCER Sandip Prasad, Xiangmei Gu, Stuart Lipsitz, Jim Hu, and Scott Eggener Sandip PrasadSandip Prasad Chicago, IL More articles by this author , Xiangmei GuXiangmei Gu Boston, MA More articles by this author , Stuart LipsitzStuart Lipsitz Boston, MA More articles by this author , Jim HuJim Hu Boston, MA More articles by this author , and Scott EggenerScott Eggener Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.483AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The patterns of utilization of pharmacotherapy for lower urinary tract symptoms following treatment for prostate cancer are not well characterized. Our objective was to compare the use of overactive bladder (OAB) medications, 5-alpha reductase inhibitors (5-ARIs) and alpha blockers following radical prostatectomy (RP), external beam radiation therapy and brachytherapy (RT), androgen deprivation therapy alone (ADT), and active surveillance (AS). METHODS We performed a population-based observational cohort study using Surveillance, Epidemiology and End Results-Medicare linked data to identify 9,186 men diagnosed and treated for prostate cancer in 2007 and 2008. Baseline medication use was assessed six months prior to therapy and post-treatment use was captured for the first six months following treatment from Medicare Part D. RESULTS Among newly diagnosed men, the management strategy was RT in 47%, RP in 25%, AS in 17%, and ADT alone in 11% (Table). There was no difference between groups in pre-diagnosis use of OAB medications (p=0.22). Use of preoperative 5-ARIs was lowest in men undergoing RP (2.0%) and highest in men managed with AS (4.3%; p=0.001). Baseline use of alpha blockers was greatest in men treated with RT (15.2%) and lowest in men managed with AS (9.2%; p<0.001). Following treatment, use of OAB medication increased six-fold in the RP group and doubled in RT treatment group (all p-values < 0.001). Utilization of 5-ARIs decreased after treatment in all groups except the AS group. Alpha blocker use declined after treatment in all groups except RT, where an additional 12.7% of patients began to use these medications after treatment. Following RP, 3.7% of men continued to use alpha blockers. Frequency (%) of OAB medication, 5-ARI, and alpha blocker use prior and following treatment for prostate cancer ADT (n=994) RT (n=4,319) RP (n=1,564) AS (n=2,309) p-value OAB medications Prior to treatment 1.8 1.4 0.9 1.6 0.218 After treatment 2.8 3.2 6.6 1.3 <0.001 5-ARIs Prior to treatment 3.3 3.1 2.0 4.3 0.001 After treatment 3.2 2.1 0.7 4.6 <0.001 Alpha blockers Prior to treatment 13.7 15.2 11.7 9.2 <0.001 After treatment 13.0 27.9 3.7 8.0 <0.001 CONCLUSIONS Although 5-ARIs and alpha blockers have no proven role following radical prostatectomy they are erroneously taken by a small but significant proportion of patients. Significant increases were observed for OAB medications after RP and alpha blockers after RT. Changes in medication use should be included in any comparative assessment of prostate cancer treatments. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e171 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sandip Prasad Chicago, IL More articles by this author Xiangmei Gu Boston, MA More articles by this author Stuart Lipsitz Boston, MA More articles by this author Jim Hu Boston, MA More articles by this author Scott Eggener Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...