MP24-13 PERCENTAGE AND RATIONALE OF GUIDELINE-DISCORDANT ANDROGEN DEPRIVATION THERAPY IN PROSTATE CANCER PATIENTS

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) II (MP24)1 Sep 2021MP24-13 PERCENTAGE AND RATIONALE OF GUIDELINE-DISCORDANT ANDROGEN DEPRIVATION THERAPY IN PROSTATE CANCER PATIENTS Renée Hogenhout, Ivo de Vos, Sebastiaan Remmers, Martijn Busstra, Lionne Venderbos, Monique Roobol, and the ERSPC Rotterdam Study Group Renée HogenhoutRenée Hogenhout More articles by this author , Ivo de VosIvo de Vos More articles by this author , Sebastiaan RemmersSebastiaan Remmers More articles by this author , Martijn BusstraMartijn Busstra More articles by this author , Lionne VenderbosLionne Venderbos More articles by this author , Monique RoobolMonique Roobol More articles by this author , and the ERSPC Rotterdam Study Group More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002015.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recommendations on Androgen Deprivation Therapy (ADT) for prostate cancer (PCa) patients arise from a critical appraisal of scientific evidence which is a lot of work. Despite these efforts, the known side-effects of ADT and the lack of benefit in certain risk groups, guidelines may not always be adhered to. Here, we determined guideline adherence to ADT recommendations and analyzed the physicians’ motivation in case of disconcordance. METHODS: We included subjects from the Rotterdam section of the European Randomized Study of Screening for PCa who were diagnosed with PCa in all stages since the publication of the first EAU guidelines on PCa in 2001 up to and including 2019, and received any form of ADT within the first year after diagnosis. They were categorized into guideline-concordant or -discordant ADT according to the EAU guidelines recommendations within the study period. RESULTS: A total of 1037/3211 (32%) men diagnosed with PCa received ADT within the first year after diagnosis, of which 162/1037 (16%) men received guideline-discordant ADT. In 79% (823/1037) ADT was administered guideline-concordant and in 4% (45/1037) adherence was not assessable due to incomplete medical files. In seven patients (4%) who were unfit/unwilling for curative treatment, lower urinary tract symptoms (LUTS) contributed to the decision to prescribe ADT monotherapy. These cases were also considered as not assessable since LUTS is not clearly defined as “symptomatic” in the guideline. Most of the guideline discordance was noticed in patients receiving ADT monotherapy for intermediate- and high-risk PCa (73%). A common reason for discordant prescription of ADT as monotherapy in this group was suspicion of (lymph node) metastases due to high PSA level (28%). Other reasons were unwillingness (24%) and/or unfitness (51%) to undergo curative treatment without being symptomatic. Three patients (3%) were symptomatic but not unfit or unwilling for curative treatment. In 16% of the discordant cases, prescription of ADT monotherapy was not motivated. CONCLUSIONS: Guidelines and clinical practice do not necessarily correspond. Physicians did not adhere to EAU guidelines on ADT in a Dutch cohort in 16% of the cases. However, guideline-discordant prescription of ADT may not always indicate “inappropriate” treatment. Physicians are able to make a more nuanced clinical assessment taking into account comorbidities, patients’ wishes and social context. Although guidelines support clinical decision-making, better defined and more tailored guidelines are needed. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e416-e417 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Renée Hogenhout More articles by this author Ivo de Vos More articles by this author Sebastiaan Remmers More articles by this author Martijn Busstra More articles by this author Lionne Venderbos More articles by this author Monique Roobol More articles by this author the ERSPC Rotterdam Study Group More articles by this author Expand All Advertisement Loading ...