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. 2006 Nov;98(5):973-8.
doi: 10.1111/j.1464-410X.2006.06416.x. Epub 2006 Jul 28.

The rising prevalence of androgen deprivation among older American men since the advent of prostate-specific antigen testing: a population-based cohort study

Michael J Barry  1 , Michael A Delorenzo, Elizabeth S Walker-Corkery, F Lee Lucas, David C Wennberg
Affiliations

The rising prevalence of androgen deprivation among older American men since the advent of prostate-specific antigen testing: a population-based cohort study

Michael J Barry et al. BJU Int. 2006 Nov.

Abstract

Objective: To investigate the effect of efforts in the early detection of prostate cancer using prostate-specific antigen (PSA) testing in the USA, by estimating the regional prevalence of androgen deprivation therapy (ADT) among older men in 1993-2000, and correlating the prevalence with early detection and aggressive treatment rates in 1987-91, as some authors predicted that ADT, a treatment traditionally reserved for advanced prostate cancer, would become less common over time as a result of such efforts.

Patients and methods: A sample of 5% of men who were Medicare beneficiaries was used in this prospective population-based cohort study. The main outcome measures were the overall prevalence of ADT (medical and surgical) in the cohort from 1993 to 2000, and correlations between rates of prostate procedures in the 306 USA hospital referral regions in 1987-91 and prevalence of ADT in those regions from 1993 to 2000.

Results: The prevalence of ADT among these men in the USA increased steadily from 1.8% in 1993 to 2.9% in 2000 (P < 0.001). Regions with higher rates of prostate biopsy in 1987-91 had a higher prevalence of ADT in 1993, 1995 and 1997 (P < 0.05). Regions with higher rates of transurethral prostatectomy in 1987-91 had a higher prevalence of ADT in 1993-2000 (P < 0.01). Regions with higher rates of radical prostatectomy in 1987-91 had higher rates of ADT in 1993-99 (P < 0.05).

Conclusions: Widespread early detection and aggressive treatment for prostate cancer in the USA has been associated with more, not less, ADT among older men over time.

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Conflict of interest statement

CONFLICT OF INTEREST

None declared.

Figures

FIG. 1
FIG. 1
Cross-sectional prevalence of surgical and medical ADT in men in the USA Medicare population, 1993–2000.
FIG. 2
FIG. 2
Variation among the rates of age- and race-adjusted rates of prostate biopsy, TURP and RP in the early PSA era (1987–91) among men who were Medicare beneficiaries in 306 USA HRRs. *Scale for Radical Prostatectomy y axis differs to accommodate rate range.
FIG. 3
FIG. 3
Variation among the prevalence of ADT in 1993 and 2000 among men who were Medicare beneficiaries in 306 USA HRRs.
See this image and copyright information in PMC

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