The following is a summary of “Variation in Androgen Deprivation Therapy Use Among Men with Intermediate Risk Prostate Cancer: Results from a Statewide Radiation Oncology Quality Consortium,” published in the June 2024 issue of Oncology by Dykstra et al.

For men with intermediate-risk prostate cancer treated with definitive therapy, the addition of androgen deprivation therapy (ADT) reduces the risk of distant metastasis and cancer-related mortality. However, the absolute benefit of ADT varies by baseline cancer risk. With advancements in prognosis estimation, understanding ADT decision-making in the modern era is crucial. This study aimed to characterize the variability and identify factors associated with intended ADT use within a statewide quality consortium.

From June 9, 2020, to June 26, 2023, 815 patients with localized prostate cancer undergoing definitive radiotherapy were enrolled. Prospective data was collected using standardized patient, physician, and physicist forms. The primary outcome was the intended use of ADT. Multivariable analyses (MVA) tested associations with patient, tumor, and practice-related factors while random intercept modeling estimated facility-level variability.

Among 570 patients with intermediate-risk disease across 26 facilities, 46% (n=262) were intended for ADT. There was a significant difference in ADT use between NCCN favorable intermediate-risk (FIR) (23.5%, n=38/172) and unfavorable intermediate-risk (UIR) disease (56.3%, n=224/398), p<0.001. Adjusting for the statewide case mix, the predicted probability of intended ADT use varied significantly across facilities, ranging from 15.4% (95% CI 5.4-37.0%) to 71.7% (95% CI 57.0-82.9%), p<0.01. MVA indicated that grade group 3 (OR 4.60 [3.20-6.67]), ≥50% positive cores (OR 2.15 [1.43-3.25]), and PSA 10-20 (OR 1.87 [1.24-2.84]) were associated with ADT use. The AUC improved when incorporating MRI adverse features (0.76) or radiation treatment variables (0.76), but significant facility-level heterogeneity persisted in all models evaluated (p<0.05).

Within a statewide consortium, there is substantial facility-level heterogeneity in intended ADT use for men with intermediate-risk prostate cancer. Future efforts are necessary to identify patients who will benefit most from ADT and to develop strategies to standardize appropriate use.

Source: sciencedirect.com/science/article/abs/pii/S0360301624006898