Influencing factors while prescribing androgen deprivation therapy for carcinoma prostate in clinical practice: When literature is not enough!

Abstract

Objective: Androgen deprivation therapy (ADT) is an integral part of prostate cancer management but its clinical use remains controversial. Materials and Methods: We retrospectively analyzed 91 patients with prostate cancer treated between 2007 and 2014 to determine the factors that influenced our physician’s decisions regarding ADT prescription. Results: Of the 55 radically treated cases, the mean age was found to be 67 years with comorbidities present in 67% cases. Overall, 26% patients were symptomatic at presentation with 0%, 19%, and 81% cases in low-, intermediate-, and high-risk (HR) category, respectively. When divided into two groups, ADT (41 cases) and NADT (non-ADT, 14 cases), more HR cases (80% vs. 20%, P = 0.05) and all patients with positive nodes fell in ADT group (P = 0.05). Patients in ADT group had a significantly higher mean initial prostate-specific antigen (iPSA) than that of NADT group (54.2 vs. 13.9ng/mL; P = 0.02). Treatment outcomes and toxicities remained comparable between the two groups. Overall, 74% patients obtained response to primary treatment (75.6% in ADT and 71.4% in NADT) with 10 patients experiencing disease progression during follow-up (FU). Mean progression-free survival was 43 and 32 months in ADT and NADT group, respectively (P = 0.24). Median FU was 54.9 and 35.5 months in ADT and NADT group, respectively (P = 0.29). At last FU, 91% patients were alive (88% in ADT and 100% in NADT) with 67% in disease-free status. Conclusion: Prognostic risk grouping, node positivity, and high iPSA emerged as significant factors that influenced decisions regarding ADT prescription. Other factors such as age, comorbidities, symptoms, Gleason score, and T-stage were found to be insignificant.