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

Authors

  • Vahakn B. Shahinian M.D.,

    Corresponding author
    1. Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    2. Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
    • Department of Internal Medicine, University of Texas Medical Branch, John Sealy Annex 4.200, 301 University Boulevard, Galveston, TX 77555-0562
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    • Fax: (409) 772-5451

  • Yong-fang Kuo Ph.D.,

    1. Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    2. Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
    3. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
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  • Jean L. Freeman Ph.D.,

    1. Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    2. Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
    3. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
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  • Eduardo Orihuela M.D.,

    1. Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, Texas
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  • James S. Goodwin M.D.

    1. Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    2. Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
    3. Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
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  • The current study used the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute (Bethesda, MD); the Office of Research, Development and Information, Centers for Medicare and Medicaid Services (CMS; Baltimore, MD); Information Management Services, Inc. (Silver Springs, MD); and the SEER program tumor registries in the creation of the SEER-Medicare database.

Abstract

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.

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