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Differential utilization of medical versus surgical androgen deprivation therapy for metastatic prostate cancer
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November 16 2018
Source: Cancer. 125(3):453-462
Details:
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Alternative Title:Cancer
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Personal Author:
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Description:Objective:
Surgical and medical androgen deprivation therapy (ADT) strategies are comparable in their ability to suppress serum testosterone levels as treatment in metastatic prostate cancer but differ in cost and impact on quality of life. Medical ADT is associated with better long-term quality of life due to the flexibility of possible therapy interruption but comes with a higher cumulative cost. We examined if surgical ADT (i.e., bilateral orchiectomy) was differentially utilized by race/ethnicity and other social factors.
Methods
We identified patients with metastatic disease at diagnosis through the California Cancer Registry. The association of race/ethnicity with receipt of surgical ADT was modeled using multivariable Firth logistic regression adjusting for age, Gleason score, prostate specific antigen, clinical tumor and lymph node stage, neighborhood socioeconomic status (nSES), insurance, marital status, comorbidities, initial treatment (radiation, chemotherapy), location of care, rural/urban area, and year of diagnosis.
Results
We examined 10,675 patients with metastatic prostate cancer: Non-Hispanic (NH) Black (11.4%), Asian/Pacific Islander (8.4%), Hispanic/Latino (18.5%), and NH White (60.4%). In the multivariable model, patients more likely to receive surgical ADT were Hispanic/Latino (OR=1.32, 95% CI 1.01–1.72), from a low nSES (OR=1.96, 95% CI 1.34–2.89) or rural area (OR=1.49, 95% CI 1.15–1.92), and had Medicaid/public insurance (OR=2.21, 95% CI 1.58–3.10). Patients with Military/Veterans Administration insurance were significantly less likely to receive surgical ADT than patients with private insurance (OR=0.34, 95% CI 0.13–0.88).
Conclusion:
Race/ethnicity, neighborhood SES, and insurance are significantly associated with receipt of surgical ADT. Future research will need to characterize other differences in initial treatments among men with advanced prostate cancer based on race/ethnicity and aim to better understand what factors drive the association between surgical ADT among men of Hispanic origin or from low nSES.
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Pubmed ID:30444526
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Pubmed Central ID:PMC6340740
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