Androgen deprivation monotherapy usage in non-metastatic prostate cancer: results from eight European countries

Abstract

Introduction: The aim of this study was to investigate the attitudes towards use of androgen deprivation therapy (ADT) as monotherapy for localized or locally advanced prostate cancer (PC).

Material and methods: A survey using a 28-item, structured, quantitative questionnaire about the management of patients with PC was conducted in eight European countries between February and May 2018. Survey recipients were selected from a private database of healthcare providers.

Results: Overall, 375 physicians completed the survey (response rate, 58%). Participants were urologists (71.2%) or medical oncologists (28.8%), with a mean practice duration of 19.9 years and with university hospital or cancer center (41.6%), non-teaching hospital (38.4%) or private-sector clinic (20.0%) affiliations. Median proportions of physicians considering ADT as monotherapy to treat patients with PC in different risk groups varied between countries, but overall were: high/very high-risk, 60%; intermediate-risk, 30%; low-risk, 7.5%. The use of ADT monotherapy in the different risk groups also varied by medical specialty and type of affiliation. Proportions of participants applying different target thresholds for testosterone (T) levels also varied by country, but overall were: <50 ng/dL, 29.9%; <32 ng/dL, 4.8%; <20 ng/dL, 54.3%; castration but no specific target, 11%. More than half of participants (58.7%) determined target T levels only when prostate-specific antigen level was increased.

Conclusions: Our multinational survey provides evidence that PC management varies across European countries and with clinical context, and frequently diverges from European Association of Urology (EAU) - European Society for Radiotherapy and Oncology (ESTRO) - European Society of Urogenital Radiology (ESUR) - International Society of Geriatric Oncology (SIOG) guidelines. Strategies for effective implementation of evidence-based recommendations in clinical practice may be needed to optimize patient outcomes.

Keywords: European Association of Urology guidelines; androgen deprivation therapy; castration levels; prostate cancer; testosterone.

Figure 1

Patients receiving androgen deprivation therapy (ADT) by country and risk group. Data refer to the management of patients with localized, low-, moderate- or high-risk disease. Physicians were asked to indicate the proportion of patients in each risk group receiving ADT and so proportions in each category do not add up to 100%.

Figure 2

Physicians treating to different testosterone nadir (T) level castration targets, by country. Data refer to the management of patients with any disease stage (localized or metastatic). Categories of castration target T levels were not mutually exclusive; here, we show the proportion of physicians in each country by T level used.