PDF(Pubmed)
Abstract：
UNASSIGNED: Guidelines on androgen deprivation therapy (ADT) for prostate cancer (PCa) arise from a critical appraisal of scientific evidence, which is a costly effort. Despite these efforts and the side effects of ADT, guidelines may not always be adhered to.
UNASSIGNED: To determine ADT overtreatment in PCa patients compared to the European Association of Urology (EAU) guidelines, and to identify predictors and physicians\' motivations for this overtreatment.
UNASSIGNED: Men were included from the European Randomised study of Screening for Prostate Cancer (ERSPC) Rotterdam who were diagnosed with PCa between 2001 and 2019, and received ADT <1 yr after diagnosis.
UNASSIGNED: Patients were categorised into the concordant ADT or discordant ADT group following the EAU guidelines. Physicians\' motivations for discordancy were reported. Multivariable logistic regression was performed to identify predictors for guideline-discordant ADT including the nonlinear fit of the year of diagnosis.
UNASSIGNED: Of 3608 PCa patients, 1037 received ADT <1 yr after diagnosis. Adherence improved gradually over the study period, resulting in overall discordancy of 15%. A patient diagnosed in 2011 had 3.3 times lower risk on guideline-discordant ADT than a patient diagnosed in 2004 (odds ratio [OR] 0.30; 95% confidence interval [CI] 0.18-0.50). The most common reason for discordancy was unwillingness or unfitness for curative treatment of asymptomatic patients. Age (OR 1.19; 95% CI 1.15-1.24) and Gleason score ≥4 + 3 (OR 1.70; 95% CI 1.06-2.74) were associated with guideline-discordant ADT.
UNASSIGNED: In a Dutch cohort, slow adaptation of the EAU guidelines on ADT for PCa patients between 2001 and 2019 resulted in overall overtreatment of 15%, mostly in asymptomatic patients who were unfit or unwilling for curative treatment. Clear, structured presentation, or integration of these tailored guidelines into the electronic health record might accelerate the adaptation of future guidelines.
UNASSIGNED: Slow adaptation of the guidelines on hormonal therapy resulted in overtreatment in 15% of prostate cancer patients, mostly in asymptomatic patients who were unfit or unwilling for curative treatment.
UNASSIGNED: To determine ADT overtreatment in PCa patients compared to the European Association of Urology (EAU) guidelines, and to identify predictors and physicians\' motivations for this overtreatment.
UNASSIGNED: Men were included from the European Randomised study of Screening for Prostate Cancer (ERSPC) Rotterdam who were diagnosed with PCa between 2001 and 2019, and received ADT <1 yr after diagnosis.
UNASSIGNED: Patients were categorised into the concordant ADT or discordant ADT group following the EAU guidelines. Physicians\' motivations for discordancy were reported. Multivariable logistic regression was performed to identify predictors for guideline-discordant ADT including the nonlinear fit of the year of diagnosis.
UNASSIGNED: Of 3608 PCa patients, 1037 received ADT <1 yr after diagnosis. Adherence improved gradually over the study period, resulting in overall discordancy of 15%. A patient diagnosed in 2011 had 3.3 times lower risk on guideline-discordant ADT than a patient diagnosed in 2004 (odds ratio [OR] 0.30; 95% confidence interval [CI] 0.18-0.50). The most common reason for discordancy was unwillingness or unfitness for curative treatment of asymptomatic patients. Age (OR 1.19; 95% CI 1.15-1.24) and Gleason score ≥4 + 3 (OR 1.70; 95% CI 1.06-2.74) were associated with guideline-discordant ADT.
UNASSIGNED: In a Dutch cohort, slow adaptation of the EAU guidelines on ADT for PCa patients between 2001 and 2019 resulted in overall overtreatment of 15%, mostly in asymptomatic patients who were unfit or unwilling for curative treatment. Clear, structured presentation, or integration of these tailored guidelines into the electronic health record might accelerate the adaptation of future guidelines.
UNASSIGNED: Slow adaptation of the guidelines on hormonal therapy resulted in overtreatment in 15% of prostate cancer patients, mostly in asymptomatic patients who were unfit or unwilling for curative treatment.
摘要：
■前列腺癌（PCa）的雄激素剥夺治疗（ADT）指南源于对科学证据的严格评估，这是一项昂贵的努力。尽管这些努力和ADT的副作用，准则可能并不总是得到遵守。
■为了确定与欧洲泌尿外科协会（EAU）指南相比，PCa患者的ADT过度治疗，并确定这种过度治疗的预测因素和医生的动机。
■男性纳入了2001年至2019年间诊断为PCa的鹿特丹前列腺癌筛查（ERSPC）欧洲随机研究，并在诊断后<1年接受ADT。
■患者按照EAU指南分为一致ADT或不一致ADT组。医生报告了不一致的动机。进行多变量逻辑回归以确定指南不一致ADT的预测因子，包括诊断年份的非线性拟合。
■3608名PCa患者，1037例诊断后ADT<1年。在研究期间，依从性逐渐提高，导致15%的总体不一致。2011年诊断的患者的指南不一致ADT风险比2004年诊断的患者低3.3倍(比值比[OR]0.30;95%置信区间[CI]0.18-0.50)。不一致的最常见原因是不愿意或不适合无症状患者的治愈性治疗。年龄(OR1.19;95%CI1.15-1.24)和Gleason评分≥4+3(OR1.70;95%CI1.06-2.74)与指南不一致的ADT相关。
■在荷兰队列中，2001年至2019年期间，EAU对PCa患者ADT指南的缓慢适应导致总体过度治疗15%，大多数无症状患者不适合或不愿意接受治疗。清除,结构化演示，或将这些量身定制的指南整合到电子健康记录中可能会加速未来指南的适应。
■激素治疗指南的缓慢适应导致15％的前列腺癌患者过度治疗，大多数无症状患者不适合或不愿意接受治疗。
■为了确定与欧洲泌尿外科协会（EAU）指南相比，PCa患者的ADT过度治疗，并确定这种过度治疗的预测因素和医生的动机。
■男性纳入了2001年至2019年间诊断为PCa的鹿特丹前列腺癌筛查（ERSPC）欧洲随机研究，并在诊断后<1年接受ADT。
■患者按照EAU指南分为一致ADT或不一致ADT组。医生报告了不一致的动机。进行多变量逻辑回归以确定指南不一致ADT的预测因子，包括诊断年份的非线性拟合。
■3608名PCa患者，1037例诊断后ADT<1年。在研究期间，依从性逐渐提高，导致15%的总体不一致。2011年诊断的患者的指南不一致ADT风险比2004年诊断的患者低3.3倍(比值比[OR]0.30;95%置信区间[CI]0.18-0.50)。不一致的最常见原因是不愿意或不适合无症状患者的治愈性治疗。年龄(OR1.19;95%CI1.15-1.24)和Gleason评分≥4+3(OR1.70;95%CI1.06-2.74)与指南不一致的ADT相关。
■在荷兰队列中，2001年至2019年期间，EAU对PCa患者ADT指南的缓慢适应导致总体过度治疗15%，大多数无症状患者不适合或不愿意接受治疗。清除,结构化演示，或将这些量身定制的指南整合到电子健康记录中可能会加速未来指南的适应。
■激素治疗指南的缓慢适应导致15％的前列腺癌患者过度治疗，大多数无症状患者不适合或不愿意接受治疗。
