Importance: Understanding trends in the use of hormonal therapy (HT) for prostate cancer (PCa) is crucial to optimize treatment strategies, particularly for older men with locally advanced and metastatic disease. Objective: To evaluate changes in the patterns of adjuvant and primary HT use over time in older U.S. men diagnosed with locally advanced and metastatic prostate cancer. Design, Setting, and Participants: This cohort study utilized SEER-Medicare data, which covers approximately 48% of the U.S. population and links cancer registry data with Medicare claims, including 149,515 men aged ≥66 years diagnosed with PCa between 2010 and 2019. We analyzed trends in the use of adjuvant HT for higher-risk and primary HT for lower-risk PCa. Multivariable logistic regression models were used to adjust for clinical and demographic factors. Main Outcomes and Measures: The primary outcome was the proportion of men receiving any form of HT within 6 months of PCa diagnosis. HT included injectable Gonadotropin-releasing hormone (GnRH) agonists and antagonists, orchiectomy, and anti-androgens agents. Results: The rate of adjuvant HT in higher-risk PCa patients increased significantly from 53.6% in 2010 to 68.1% in 2019 (p< 0.0001), with a steady rise in the last four years. In contrast, the rate of men with lower-risk disease receiving primary HT declined from 25% in 2010 to 16.9% in 2013, then peaked at 28.2% in 2015, and stabilized between 25% and 27.3% from 2017 to 2019. The overall HT usage increased from 33.5% in 2010 to 45.2% in 2019, showing a consistent increase over the years. These patterns persisted after adjusting for clinical and demographic factors. Conclusions and Relevance: The increasing use of adjuvant HT in higher-risk PCa patients aligns with evolving treatment guidelines, while the stable rate of primary HT in lower-risk patients represents persistent inappropriate use and highlights the need for further efforts to optimize treatment choices. While previous studies focused on men with intermediate-risk PCa receiving radiation therapy, our study broadens the scope to include men who did not undergo radiation therapy, providing a more inclusive view of HT trends. Future research should focus on refining strategies to reduce inappropriate primary HT use and improve adjuvant HT administration.
重要性：了解前列腺癌激素治疗的使用趋势对于优化治疗策略至关重要，特别是对于患有局部晚期和转移性疾病的老年男性。目的：评估美国老年男性在诊断为局部晚期和转移性前列腺癌后，辅助激素治疗和主要激素治疗使用模式随时间的变化。设计、设置和参与者：这项队列研究利用了SEER-Medicare数据，该数据覆盖了约48%的美国人口，并将癌症登记数据与医疗保险索赔数据关联，包括2010年至2019年间诊断为前列腺癌的149,515名年龄≥66岁的男性。我们分析了高风险前列腺癌患者辅助激素治疗和低风险前列腺癌患者主要激素治疗的使用趋势。采用多变量逻辑回归模型对临床和人口统计学因素进行调整。主要结果和测量指标：主要结果是前列腺癌诊断后6个月内接受任何形式激素治疗的男性比例。激素治疗包括注射用促性腺激素释放激素激动剂和拮抗剂、睾丸切除术以及抗雄激素药物。结果：高风险前列腺癌患者的辅助激素治疗率从2010年的53.6%显著上升至2019年的68.1%（p<0.0001），并在最后四年持续稳步增长。相比之下，低风险疾病患者接受主要激素治疗的比例从2010年的25%下降至2013年的16.9%，随后在2015年达到峰值28.2%，并在2017年至2019年间稳定在25%至27.3%之间。总体激素治疗使用率从2010年的33.5%上升至2019年的45.2%，呈现逐年持续增长的趋势。这些模式在调整临床和人口统计学因素后依然存在。结论和相关性：高风险前列腺癌患者辅助激素治疗使用的增加与不断演变的治疗指南相符，而低风险患者主要激素治疗率的稳定则反映了持续的不当使用，并突显了进一步优化治疗选择的必要性。以往的研究主要关注接受放射治疗的中危前列腺癌男性，而本研究将范围扩大到未接受放射治疗的男性，提供了更全面的激素治疗趋势视角。未来的研究应侧重于完善策略，以减少不当的主要激素治疗使用，并优化辅助激素治疗的实施。
Hormonal Therapy Patterns in Older Men with Prostate Cancer in the United States, 2010–2019
肿瘤(癌症)患者之家