Neoadjuvant Androgen Deprivation Therapy Prior to Radical Prostatectomy: Recent Trends in Utilization and Association with Postoperative Surgical Margin Status
In this study, we sought to describe the contemporary trends in utilization of neoadjuvant androgen deprivation therapy (ADT). As a secondary endpoint, we assessed the community-level effect of neoadjuvant ADT on positive surgical margins after radical prostatectomy (RP).
Using the National Cancer Database (2004–2014), we identified patients with clinically localized prostate cancer (PCa) [cT1-4N0M0] treated with RP. The estimated annual percentage change (EAPC) mixed linear regression methodology was used for temporal trend analysis of neoadjuvant ADT. Observed differences in baseline characteristics between patients treated with neoadjuvant ADT versus those who were not were then controlled for using an inverse probability of treatment weighting (IPTW) approach. IPTW-adjusted analyses were then performed to examine the odds of positive surgical margins.
Overall, 8184 (2.12%) and 377,843 (97.88%) individuals with PCa were treated with neoadjuvant ADT prior to RP versus RP only, respectively. There was a consistent trend in decreasing use of neoadjuvant ADT over time, with a nadir observed in 2011 [EAPC − 8.08; 95% confidence interval (CI) − 11.7 to − 4.32; p < 0.05]. In IPTW-adjusted analyses, the odds of positive surgical margins were lower in patients receiving neoadjuvant ADT with low-risk [odds ratio (OR) 0.65; 95% CI 0.51–0.84; p < 0.001] and intermediate-risk [OR 0.76; 95% CI 0.69–0.85; p < 0.001] PCa.
After a period of steady decline, there appears to be a modest trend towards increased utilization of neoadjuvant ADT in more recent years. We found an association between neoadjuvant ADT and decreased odds of positive surgical margins among low- and intermediate-risk patients.
Quoc-Dien Trinh is supported by the Brigham Research Institute Fund to Sustain Research Excellence, the Bruce A. Beal and Robert L. Beal Surgical Fellowship, the Genentech Bio-Oncology Career Development Award from the Conquer Cancer Foundation of the American Society of Clinical Oncology (Grant No. 10202), a Health Services Research pilot test grant from the Defense Health Agency, the Clay Hamlin Young Investigator Award from the Prostate Cancer Foundation (Grant No. 16YOUN20), and an unrestricted educational Grant from the Vattikuti Urology Institute.
Quoc-Dien Trinh reports consulting fees from Bayer and Astellas. Adam S. Kibel reports consulting fees from Profound, Janssen and ConfirmMDX. Tyler R. McClintock, Nicolas von Landenberg, Alexander P. Cole, Stuart R. Lipsitz, Philipp Gild, Maxine Sun, Sean A. Fletcher, Florian Roghmann, Mani Menon, Paul L. Nguyen, Joachim Noldus, and Toni K. Choueiri have no conflicts of interest to declare.
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