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Characteristics of Urologists Predict the Use of Androgen Deprivation Therapy for Prostate Cancer

Vahakn B. Shahinian, Yong-fang Kuo, Jean L. Freeman, Eduardo Orihuela, James S. Goodwin

From the Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and the Department of Internal Medicine, the Department of Preventive Medicine and Community Health, the Department of Surgery Division of Urology, and the Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX

Address reprint requests to Vahakn B. Shahinian, MD, University of Michigan, 102 Observatory Rd, Simpson Memorial Institute Room 301, Ann Arbor, MI 48109-0725; e-mail: vahakn{at}umich.edu

Purpose: We previously have reported wide variations among urologists in the use of androgen deprivation for prostate cancer. Using the Surveillance, Epidemiology, and End Results–Medicare linked database, we examined how individual urologist characteristics influenced the use of androgen deprivation therapy.

Methods: Participants included 82,375 men with prostate cancer who were diagnosed from January 1, 1992, through December 31, 2002, and the 2,080 urologists who provided care to them. Multilevel analyses were used to estimate the likelihood of androgen deprivation use within 6 months of diagnosis in the overall cohort, in a subgroup in which use would be of uncertain benefit (primary therapy for localized prostate cancer), and in a subgroup in which use would be evidence-based (adjuvant therapy with radiation for locally advanced disease).

Results: In the overall cohort of patients, a multilevel model adjusted for patient characteristics, tumor characteristics, and urologist characteristics (eg, board certification, academic affiliation, patient panel size, years since medical school graduation) showed that the likelihood of androgen deprivation use was significantly greater for patients who saw urologists without an academic affiliation. This pattern also was noted when the analysis was limited to settings in which androgen deprivation would have been of uncertain benefit. Odds ratios for use in that context were 1.66 (95% CI, 1.27 to 2.16) for urologists with no academic affiliation and 1.45 (95% CI, 1.13 to 1.85) for urologists with minor versus major academic affiliations.

Conclusion: Use of androgen deprivation for prostate cancer varies by the characteristics of the urologist. Patients of non–academically affiliated urologists were significantly more likely to receive primary androgen deprivation therapy for localized prostate cancer, a setting in which the benefits are uncertain.

Supported in part by Public Health Service Grants No. RO1CA116758, P50CA105631, and R24HS011618. The funding bodies had no role in data extraction and analyses, in the writing of the manuscript, or in the decision to submit the manuscript for publication.

This study used the linked Surveillance, Epidemiology, and End Results (SEER)–Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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