Shahinian VB et al. (2007) Characteristics of urologists predict the use of androgen deprivation therapy for prostate cancer. J Clin Oncol 25: 5359–5365

Androgen deprivation therapy (ADT) has proven benefits as an adjuvant treatment for some stages of prostate cancer, but its use as primary therapy for localized disease—though increasingly common—is of uncertain benefit, especially given its potential adverse effects. Apart from prostate cancer stage, urologists' practice style seems to affect ADT prescription. To investigate this issue, Shahinian et al. examined the relationship between urologist characteristics and prescription of ADT in a cohort of 82,375 men with prostate cancer.

This US study analyzed data for men aged ≥66 years who received a diagnosis of prostate cancer between 1992 and 2002, and for the 2,080 urologists who cared for them. For the analysis, ADT use was defined as receipt of ADT within 6 months of diagnosis. Urologist characteristics, such as patient numbers and whether urologists had academic affiliation or board certification, were obtained from an American Medical Association database.

After adjustment for patient, tumor and urologist characteristics, likelihood of ADT use in the overall cohort was significantly increased for patients whose urologists were not academically affiliated. This same urologist characteristic was the only significant predictor of ADT use in a multivariable subgroup analysis of 18,211 patients with localized disease who had been given ADT as a primary therapy.

The authors suggest that clearer guidelines, particularly on inappropriate and appropriate use of ADT, could help reduce the variation in ADT prescription among urologists.