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The Impact of Comorbidity and Age on Timing of Androgen Deprivation Therapy in Men with Biochemical Recurrence after Radical Prostatectomy.

Publication ,  Journal Article
Moradzadeh, A; Howard, LE; Freedland, SJ; Amling, CL; Aronson, WJ; Cooperberg, MR; Kane, CJ; Klaassen, Z; Terris, MK; Daskivich, TJ
Published in: Urology practice
March 2021

Older men with major comorbidities have higher risks of morbidity and mortality from androgen deprivation therapy, and the benefits of immediate androgen deprivation therapy after biochemical recurrence in these men are unclear. We assessed variation in timing of androgen deprivation therapy by age and comorbidity in a cohort of men with biochemical recurrence after radical prostatectomy.We analyzed 2,097 men with biochemical recurrence after radical prostatectomy from 2000 to 2017 in the VA SEARCH database. We ascertained age and Deyo-Charlson comorbidity index scores at biochemical recurrence. Kaplan-Meier analysis and multivariable logistic regression were used to determine association of age and Deyo-Charlson comorbidity index with prostate specific antigen at the initiation of androgen deprivation therapy.In Kaplan-Meier analysis with prostate specific antigen at androgen deprivation therapy as the outcome, median prostate specific antigen at androgen deprivation therapy initiation was 6.2 ng/ml (95% CI 5.1-7.1) across all patients but differed among those who received adjuvant/salvage radiation (3.6 ng/ml, 95% CI 2.8-4.3) and those who did not (12.1 ng/ml, 95% CI 9.6-15.2, p <0.001). In multivariable Cox regression, advanced age (p=0.03) but not worse comorbidity (p=0.25) was associated higher prostate specific antigen at initiation of androgen deprivation therapy. Across all patients, prostate specific antigen at androgen deprivation therapy was lower among those <60 years old (3.7 ng/ml, 95% CI 2.6-5.8) compared to those 60-64 (5.0 ng/ml, 95% CI 3.9-6.6), 65-69 (6.6 ng/ml, 95% CI 4.9-8.8), 70-74 (8.8 ng/ml, 95% CI 6.1-12.3) and ≥75 years old (14.1 ng/ml, 95% CI 5.5-37.8). In contrast, prostate specific antigen at androgen deprivation therapy was similar among comorbidity subgroups (Deyo-Charlson comorbidity index 0: 6.3 ng/ml, 95% CI 5.0-7.9 vs Deyo-Charlson comorbidity index 3 or higher: 5.6 ng/ml, 95% CI 4.1-7.4). In general, these relationships were consistent among subgroups receiving adjuvant/salvage radiation.Men with comorbid disease at increased risk of morbidity and mortality with androgen deprivation therapy often receive androgen deprivation therapy at low prostate specific antigen values.

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Published In

Urology practice

DOI

EISSN

2352-0787

ISSN

2352-0779

Publication Date

March 2021

Volume

8

Issue

2

Start / End Page

238 / 245

Related Subject Headings

  • 4206 Public health
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

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Moradzadeh, A., Howard, L. E., Freedland, S. J., Amling, C. L., Aronson, W. J., Cooperberg, M. R., … Daskivich, T. J. (2021). The Impact of Comorbidity and Age on Timing of Androgen Deprivation Therapy in Men with Biochemical Recurrence after Radical Prostatectomy. Urology Practice, 8(2), 238–245. https://doi.org/10.1097/upj.0000000000000189
Moradzadeh, Ariel, Lauren E. Howard, Stephen J. Freedland, Christopher L. Amling, William J. Aronson, Matthew R. Cooperberg, Christopher J. Kane, Zachary Klaassen, Martha K. Terris, and Timothy J. Daskivich. “The Impact of Comorbidity and Age on Timing of Androgen Deprivation Therapy in Men with Biochemical Recurrence after Radical Prostatectomy.Urology Practice 8, no. 2 (March 2021): 238–45. https://doi.org/10.1097/upj.0000000000000189.
Moradzadeh A, Howard LE, Freedland SJ, Amling CL, Aronson WJ, Cooperberg MR, et al. The Impact of Comorbidity and Age on Timing of Androgen Deprivation Therapy in Men with Biochemical Recurrence after Radical Prostatectomy. Urology practice. 2021 Mar;8(2):238–45.
Moradzadeh, Ariel, et al. “The Impact of Comorbidity and Age on Timing of Androgen Deprivation Therapy in Men with Biochemical Recurrence after Radical Prostatectomy.Urology Practice, vol. 8, no. 2, Mar. 2021, pp. 238–45. Epmc, doi:10.1097/upj.0000000000000189.
Moradzadeh A, Howard LE, Freedland SJ, Amling CL, Aronson WJ, Cooperberg MR, Kane CJ, Klaassen Z, Terris MK, Daskivich TJ. The Impact of Comorbidity and Age on Timing of Androgen Deprivation Therapy in Men with Biochemical Recurrence after Radical Prostatectomy. Urology practice. 2021 Mar;8(2):238–245.
Journal cover image

Published In

Urology practice

DOI

EISSN

2352-0787

ISSN

2352-0779

Publication Date

March 2021

Volume

8

Issue

2

Start / End Page

238 / 245

Related Subject Headings

  • 4206 Public health
  • 3202 Clinical sciences
  • 1103 Clinical Sciences