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BJU Int. 2016 Jun;117(6):867-73. doi: 10.1111/bju.13307. Epub 2015 Sep 23.

Patterns of prescription and adherence to European Association of Urology guidelines on androgen deprivation therapy in prostate cancer: an Italian multicentre cross-sectional analysis from the Choosing Treatment for Prostate Cancer (CHOICE) study.

Author information

1
Department of Urology, University of Catania, Catania, Italy.
2
Department of Urology, Sant' Andrea Hospital, 'La Sapienza' University of Roma, Roma, Italy.
3
S.O. Oncologia Radioterapica, Pordenone, Italy.
4
Urology, Presidio Ospedaliero Gradenigo, Torino, Italy.
5
Radiotherapy, IRCC Candiolo, Torino, Italy.
6
Radiotherapy, A.O. Santa Maria, Terni, Italy.
7
Department of Urology, University of Padova, Padova, Italy.
8
Department of Urology, University of Perugia, Perugia, Italy.
9
Department of Urology, Università Federico II of Napoli, Napoli, Italy.
10
Department of Urology, University of Firenze, Firenze, Italy.
11
Urologia I, Azienda Ospedaliera San Paolo, Milano, Italy.
12
Radiotherapy, ASL of Cagliari, Cagliari, Italy.
13
Radiotherapy, AOU University S. Giovanni Battista Molinette, Torino, Italy.
14
Department of Urology, University of Milano, Milano, Italy.
15
Urology, University Hospital 'Maggiore della Carità', Novara, Italy.
16
Urology, University of Bari, Bari, Italy.
17
Urology, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Italy.
18
Department of Urology, University Tor Vergata, Roma, Italy.
19
Urology, Ospedale Civile Ramazzini, Carpi, Italy.
20
Department of Urology, University of Brescia, Brescia, Italy.
21
Department of Surgery, Urology Clinic, AOUI Verona, Verona, Italy.
22
Department of Urology, University of Genova, Genova, Italy.
23
Urology, Centro Uro-Andrologico La CURA, Acireale, Italy.
24
Radiotherapy, AO S. Giovanni Addolorata, Roma, Italy.
25
Radiotherapy, Istituto Nazionale per la Ricerca, Genova, Italy.
26
Department of Urology, University of Chieti, Chieti, Italy.
27
Department of Urology, University of Trieste, Trieste, Italy.
28
Radiotherapy, Policlinico Universitario Agostino Gemelli, Roma, Italy.
29
Department of Surgical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy.
30
Urology, Fondazione Istituto San Raffaele - G. Giglio di Cefalù, Cefalù, Italy.
31
Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.

Abstract

OBJECTIVE:

To evaluate both the patterns of prescription of androgen deprivation therapy (ADT) in patients with prostate cancer (PCa) and the adherence to European Association of Urology (EAU) guidelines for ADT prescription.

METHODS:

The Choosing Treatment for Prostate Cancer (CHOICE) study was an Italian multicentre cross-sectional study conducted between December 2010 and January 2012. A total of 1 386 patients, treated with ADT for PCa (first prescription or renewal of ADT), were selected. With regard to the EAU guidelines on ADT, the cohort was categorized into discordant ADT (Group A) and concordant ADT (Group B).

RESULTS:

The final cohort included 1 075 patients with a geographical distribution including North Italy (n = 627, 58.3%), Central Italy (n = 233, 21.7%) and South Italy (n = 215, 20.0%). In the category of patients treated with primary ADT, a total of 125 patients (56.3%) were classified as low risk according to D'Amico classification. With regard to the EAU guidelines, 285 (26.51%) and 790 patients (73.49%) were classified as discordant (Group A) and concordant (Group B), respectively. In Group A, patients were more likely to receive primary ADT (57.5%, 164/285 patients) than radical prostatectomy (RP; 30.9%, 88/285 patients), radiation therapy (RT; 6.7%, 19/285 patients) or RP + RT (17.7%, 14/285 patients; P < 0.01). Multivariate logistic regression analysis, adjusted for clinical and pathological variables, showed that patients from Central Italy (odds ratio [OR] 2.86; P < 0.05) and South Italy (OR 2.65; P < 0.05) were more likely to receive discordant ADT.

CONCLUSION:

EAU guideline adherence for ADT was low in Italy and was influenced by geographic area. Healthcare providers and urologists should consider these results in order to quantify the inadequate use of ADT and to set policy strategies to overcome this risk.

KEYWORDS:

European Association of Urology; adherence; androgen deprivation therapy; guidelines; prostate cancer

PMID:
26332130
DOI:
10.1111/bju.13307
[Indexed for MEDLINE]
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