Increasing use of gonadotropin‐releasing hormone agonists for the treatment of localized prostate carcinoma

• Published in: Cancer 2005-04, Vol.103 (8), p.1615-1624
• Main Authors: Shahinian, Vahakn B., Kuo, Yong‐fang, Freeman, Jean L., Orihuela, Eduardo, Goodwin, James S.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal - therapeutic use; Databases as Topic; Epidemiology and End Results program; Fertility Agents, Female - agonists; Gonadotropin-Releasing Hormone - agonists; goserelin; Goserelin - therapeutic use; Humans; leuprolide; Male; Medicare; Neoplasm Staging; Orchiectomy; Predictive Value of Tests; prostatic neoplasm; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - secondary; Prostatic Neoplasms - surgery; Registries; SEER Program; Surveillance; Time Factors; Treatment Outcome
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.20955

BACKGROUND The role of androgen deprivation therapy in prostate carcinoma is controversial in earlier stages of disease. The authors examined the time trends and patterns of use for androgen deprivation in the form of gonadotropin‐releasing hormone (GnRH) agonists or orchiectomy, in population‐based tumor registries. METHODS Data were obtained from the linked Surveillance, Epidemiology and End Results‐Medicare database. A total of 100,274 men with prostate carcinoma diagnosed from 1991 through 1999 were selected. The main outcome was the proportion of men who received ≥ 1 dose of a GnRH agonist in the first 6 months of diagnosis. This was plotted by year and stratified for age, grade, stage as well as primary versus adjuvant usage. Multiple logistic regression was used to examine predictors of GnRH agonist use in the subset of patients with localized cancer. RESULTS There was a consistent increase in GnRH agonist use by year for all ages, stages, and grades. Even in men ≥ 80 years with localized stage and low to moderate grade tumors, primary GnRH agonist use increased over the study period, from 3.7% in 1991 to 30.9% in 1999 (P < 0.001). The multivariable analysis showed that significant variability in GnRH agonist use existed among SEER geographic regions. CONCLUSIONS The use of GnRH agonists for prostate carcinoma increased dramatically during the 1990s. This increase occurred across all stages and histologic grades of prostate carcinoma, and was greatest in patients ≥ 80 years. Cancer 2005. © 2005 American Cancer Society. The use of gonadotropin‐releasing hormone agonists for the treatment of prostate carcinoma has increased dramatically during the 1990s. Large geographic variations in use may be a reflection of the uncertainty about the risks and benefits of androgen deprivation therapy.