# Hormonal Therapy Patterns in Older Men with Prostate Cancer in the United States, 2010–2019

## TL;DR

This study shows that hormonal therapy use for prostate cancer in older U.S. men increased over time, especially for high-risk cases, but inappropriate use in low-risk cases remains a concern.

## Contribution

The study provides a comprehensive analysis of hormonal therapy trends in older men with prostate cancer, including those not receiving radiation therapy.

## Key findings

- Adjuvant hormonal therapy use in higher-risk prostate cancer patients increased from 53.6% in 2010 to 68.1% in 2019.
- Primary hormonal therapy use in lower-risk patients fluctuated but remained persistently high, indicating inappropriate treatment.
- Overall hormonal therapy use increased from 33.5% in 2010 to 45.2% in 2019.

## Abstract

Hormonal therapy is a mainstay treatment for men with prostate cancer, especially those with advanced disease. However, how and when it is used has changed over time, and understanding these changes is important to ensure that patients receive the most appropriate care. In this study, we examined national data on older men with prostate cancer between 2010 and 2019 to see how the use of hormonal therapy has shifted. We found that use of hormonal therapy after diagnosis of higher-risk prostate cancer has steadily increased, while use of hormonal therapy as the only treatment in lower-risk cases has highlighted persistent inappropriate use. These findings provide important insight into how treatment choices have evolved and highlight opportunities to improve care by limiting inappropriate treatment and ensuring that men who may benefit most are receiving it.

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.