A survey of urologists on gonadotropin-releasing hormone agonist therapy for prostate cancer / 中华泌尿外科杂志

ABSTRACT

Objective:To investigate the current perceptions, treatment patterns and unmet needs of androgen deprivation therapy (ADT) on treating prostate cancer (PCa) by gonadotropin-releasing hormone agonist (GnRH-a) in Chinese urologists.Methods:The survey was conducted between July 2020 and August 2020. Questionnaires were designed to investigate the urologists employed by 163 grade A tertiary hospitals from 7 districts (North, Northeast, East, South, Central, Southwest, Northwest) across China. The inclusion criteria were urologists who had the title of attending physician or above, had experience of prescribing GnRH-a, and agreed to participate in the survey. An electronic self-administered structured questionnaire was used for data collection, with a target sample size of 300, covering treatment patterns, experience of GnRH-a prescription, and unmet needs of GnRH-a.Results:There were 13 886 questionnaires had been distributed, among which 410 questionnaires had met the inclusion criteria. After excluding 110 incomplete questionnaires, 300 valid questionnaires were included in the analysis. The average number of PCa patients administered castration treatment per urologist per month was 12±8. Monthly GnRH-a injection was more often used than quarterly GnRH-a injection[(62.0±24.7)% vs. (38.0±24.7)%]. The main follow-up frequency for patients receiving GnRH-a was once a month as reported by 49.3% (148/300) of urologists. GnRH-a injection frequency (31.3%, 94/300), prostate-specific antigen (PSA) testing frequency (27.7%, 83/300) and clinical effectiveness (26.0%, 78/300) were reported as top factors determining the follow-up frequency. Only 46.0% (138/300) urologists believed that over 70.0% of the patients were completely adherent to the prescribed treatment. When deciding which GnRH-a product to be prescribed, the top 4 factors considered by urologists were effectiveness (92.0%, 276/300), adverse events (85.7%, 257/300), economic burden (76.7%, 230/300), and frequency of injection (61.3%, 184/300). The urgency of improvement for each aspect of GnRH-a therapy was evaluated with a 5-point Likert scale (from 1 (not urgent) to 5 (extremely urgent)). The top 4 aspects needing further improvement were effectiveness (4.04±0.93), economic burden (3.93±0.84), adverse events (3.90±0.90), and frequency of injection (3.60±0.93). A 5-point Likert scale (from 1 (not influential) to 5 (extremely influential)) was also applied to evaluate factors influencing patients’ quality of life and the top 4 factors were pain (4.09±0.94), psychological stress (3.61±0.90), adverse events (3.46±0.89), and discomfort caused by frequent GnRH-a injection (3.34±0.91).Conclusions:Most urologists in China hoped that GnRH-a therapy could have reduced injection frequency, improved effectiveness, reduced economic burden and decreased adverse events in order to increase patient’s adherence and to improve the effectiveness of PCa treatment as well.