ANDROGEN DEPRIVATION THERAPY FOR ASYMPTOMATIC ADVANCED PROSTATE CANCER IN THE PROSTATE SPECIFIC ANTIGEN ERA: A NATIONAL SURVEY OF UROLOGIST BELIEFS AND PRACTICES

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Abstract
Purpose: The use of androgen deprivation for prostate cancer without symptomatic metastases to the skeleton is controversial. However, by 1995 the use of medical androgen deprivation by injection was the thirteenth largest category of physician reimbursement by Medicare. To what degree do urologist attitudes towards androgen deprivation account for this growth? Materials and Methods: A survey was mailed to 582 United States urologists practicing at least 20 hours per week in 1995 which asked about use of androgen deprivation therapy when prostate specific antigen (PSA) levels rise after primary therapy (surgery or radiation). They were also asked whether they believed androgen deprivation provided a survival benefit for patients with asymptomatic stages C and D disease. Results: The response rate was 68%. Of the respondents 68% reported that they recommend androgen deprivation at least half of the time for men whose PSA is newly or persistently elevated following radical prostatectomy. Most (81%) urologists who believe that androgen deprivation offers a survival benefit for stage C disease said they prescribed it but more than half (53%) who do not believe in the efficacy of this treatment also said they still prescribe it. Conclusions: Many urologists maintain an inclination to prescribe androgen deprivation for a rising or elevated PSA despite the absence of information about the benefit of this approach and their own conflicting beliefs.