Prevalent and incident use of androgen deprivation therapy among men with prostate cancer in the United States

Scott M. Gilbert, Yong Fang Kuo, Vahakn B. Shahinian

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Purpose: Androgen deprivation therapy (ADT) for prostate cancer increased substantially through the 1990s, but more recent national trends regarding incident and prevalent use have been incompletely characterized. Methods: Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data were used to study patterns of ADT utilization. Prevalence of ADT in the male Medicare population was estimated by examining a cohort of prostate cancer patients and a 5% noncancer control population, from 1991 to 2005. ADT use across different indications was examined for men with incident cancers from 2000 to 2002. Nested logit models were used to examine determinants of ADT use in men with lower risk prostate cancer not treated definitively by surgery or radiation. Results: Prevalent ADT use increased through the 1990s, peaked in 2000 at 3.17% of all male Medicare beneficiaries, subsequently stabilized, then dropped in 2005 to 2.92%. Between 2000 and 2002, use in incident prostate cancer was stable, with 44.8% use in all cases, 15% of cases as an adjuvant with radiation, and 14% as a primary therapy. In the nested logit model, predictors of ADT use in a lower risk setting were older age, higher stage and grade, and elevated prostate-specific antigen levels. Conclusions: Following a period of rapid expansion during the 1990s, incident and prevalent use of ADT has leveled, and may be starting to decline. Further research is needed to monitor how reductions in reimbursement for GnRH agonists will affect appropriate use of ADT as well as use in settings where its benefits may be marginal.

Original languageEnglish (US)
Pages (from-to)647-653
Number of pages7
JournalUrologic Oncology: Seminars and Original Investigations
Volume29
Issue number6
DOIs
StatePublished - Nov 2011

Fingerprint

Androgens
Prostatic Neoplasms
Medicare
Therapeutics
Logistic Models
Radiation
Prostate-Specific Antigen
Gonadotropin-Releasing Hormone
Population
Epidemiology
Research

Keywords

  • Androgen deprivation therapy
  • Practice patterns
  • Prostate cancer

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Prevalent and incident use of androgen deprivation therapy among men with prostate cancer in the United States. / Gilbert, Scott M.; Kuo, Yong Fang; Shahinian, Vahakn B.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 29, No. 6, 11.2011, p. 647-653.

Research output: Contribution to journalArticle

@article{1feb5fdfbff54f7c82abef8bd475c21a,
title = "Prevalent and incident use of androgen deprivation therapy among men with prostate cancer in the United States",
abstract = "Purpose: Androgen deprivation therapy (ADT) for prostate cancer increased substantially through the 1990s, but more recent national trends regarding incident and prevalent use have been incompletely characterized. Methods: Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data were used to study patterns of ADT utilization. Prevalence of ADT in the male Medicare population was estimated by examining a cohort of prostate cancer patients and a 5{\%} noncancer control population, from 1991 to 2005. ADT use across different indications was examined for men with incident cancers from 2000 to 2002. Nested logit models were used to examine determinants of ADT use in men with lower risk prostate cancer not treated definitively by surgery or radiation. Results: Prevalent ADT use increased through the 1990s, peaked in 2000 at 3.17{\%} of all male Medicare beneficiaries, subsequently stabilized, then dropped in 2005 to 2.92{\%}. Between 2000 and 2002, use in incident prostate cancer was stable, with 44.8{\%} use in all cases, 15{\%} of cases as an adjuvant with radiation, and 14{\%} as a primary therapy. In the nested logit model, predictors of ADT use in a lower risk setting were older age, higher stage and grade, and elevated prostate-specific antigen levels. Conclusions: Following a period of rapid expansion during the 1990s, incident and prevalent use of ADT has leveled, and may be starting to decline. Further research is needed to monitor how reductions in reimbursement for GnRH agonists will affect appropriate use of ADT as well as use in settings where its benefits may be marginal.",
keywords = "Androgen deprivation therapy, Practice patterns, Prostate cancer",
author = "Gilbert, {Scott M.} and Kuo, {Yong Fang} and Shahinian, {Vahakn B.}",
year = "2011",
month = "11",
doi = "10.1016/j.urolonc.2009.09.004",
language = "English (US)",
volume = "29",
pages = "647--653",
journal = "Urologic Oncology",
issn = "1078-1439",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Prevalent and incident use of androgen deprivation therapy among men with prostate cancer in the United States

AU - Gilbert, Scott M.

AU - Kuo, Yong Fang

AU - Shahinian, Vahakn B.

PY - 2011/11

Y1 - 2011/11

N2 - Purpose: Androgen deprivation therapy (ADT) for prostate cancer increased substantially through the 1990s, but more recent national trends regarding incident and prevalent use have been incompletely characterized. Methods: Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data were used to study patterns of ADT utilization. Prevalence of ADT in the male Medicare population was estimated by examining a cohort of prostate cancer patients and a 5% noncancer control population, from 1991 to 2005. ADT use across different indications was examined for men with incident cancers from 2000 to 2002. Nested logit models were used to examine determinants of ADT use in men with lower risk prostate cancer not treated definitively by surgery or radiation. Results: Prevalent ADT use increased through the 1990s, peaked in 2000 at 3.17% of all male Medicare beneficiaries, subsequently stabilized, then dropped in 2005 to 2.92%. Between 2000 and 2002, use in incident prostate cancer was stable, with 44.8% use in all cases, 15% of cases as an adjuvant with radiation, and 14% as a primary therapy. In the nested logit model, predictors of ADT use in a lower risk setting were older age, higher stage and grade, and elevated prostate-specific antigen levels. Conclusions: Following a period of rapid expansion during the 1990s, incident and prevalent use of ADT has leveled, and may be starting to decline. Further research is needed to monitor how reductions in reimbursement for GnRH agonists will affect appropriate use of ADT as well as use in settings where its benefits may be marginal.

AB - Purpose: Androgen deprivation therapy (ADT) for prostate cancer increased substantially through the 1990s, but more recent national trends regarding incident and prevalent use have been incompletely characterized. Methods: Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data were used to study patterns of ADT utilization. Prevalence of ADT in the male Medicare population was estimated by examining a cohort of prostate cancer patients and a 5% noncancer control population, from 1991 to 2005. ADT use across different indications was examined for men with incident cancers from 2000 to 2002. Nested logit models were used to examine determinants of ADT use in men with lower risk prostate cancer not treated definitively by surgery or radiation. Results: Prevalent ADT use increased through the 1990s, peaked in 2000 at 3.17% of all male Medicare beneficiaries, subsequently stabilized, then dropped in 2005 to 2.92%. Between 2000 and 2002, use in incident prostate cancer was stable, with 44.8% use in all cases, 15% of cases as an adjuvant with radiation, and 14% as a primary therapy. In the nested logit model, predictors of ADT use in a lower risk setting were older age, higher stage and grade, and elevated prostate-specific antigen levels. Conclusions: Following a period of rapid expansion during the 1990s, incident and prevalent use of ADT has leveled, and may be starting to decline. Further research is needed to monitor how reductions in reimbursement for GnRH agonists will affect appropriate use of ADT as well as use in settings where its benefits may be marginal.

KW - Androgen deprivation therapy

KW - Practice patterns

KW - Prostate cancer

UR - http://www.scopus.com/inward/record.url?scp=81055123873&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=81055123873&partnerID=8YFLogxK

U2 - 10.1016/j.urolonc.2009.09.004

DO - 10.1016/j.urolonc.2009.09.004

M3 - Article

C2 - 19926311

AN - SCOPUS:81055123873

VL - 29

SP - 647

EP - 653

JO - Urologic Oncology

JF - Urologic Oncology

SN - 1078-1439

IS - 6

ER -