Longitudinal Changes in Metabolic Syndrome Risk Factors (MSRF) Screening and Treatment Rates Between 2010 and 2021 Among Patients With Prostate Cancer (PCa) Treated With Androgen Deprivation Therapy (ADT)

OBJECTIVES: ADT is widely used in treating localized or metastatic PCa and associated with toxic cardiovascular/metabolic adverse events that may occur 6-months after therapy initiation. A 2010 science advisory guideline for providers caring for PCa patients included MSRF evaluation within 6-months of ADT initiation and annual assessment thereafter. Similarly, in 2010, the USFDA issued a drug safety communication regarding increased CVD risk (AMI, stroke, sudden cardiac death) and T2DM among patients treated with one class of ADT medications, GnRH agonists. We hypothesized that awareness, uptake and adherence to the 2010 guidelines would increase/optimize MSRF screening/treatment rates over time. This study assessed longitudinal changes in MSRF screening/treatment rates between 2010 and 2021 among ADT treated PCa patients at a university-affiliated comprehensive cancer center in the southwestern U.S.

METHODS: A retrospective observational cohort study of 803 PCa patients treated with ADT for at least 6-months. Patients followed 3-months pre to 12-months post ADT initiation to evaluate MSRF screening/treatment. MSRF screening determination included MSRF screening/treatment referral or receipt of blood glucose, lipid profile, and blood pressure screening within 6-months ADT treatment. Patients were MSRF treated if they started/continued recommend therapy within 6-months of ADT initiation.

RESULTS: Mean annual MSRF screening rate was low (23.5%). 2010 screening rate (22.5%) increased to 35.6% in 2015, low of 13.9% in 2019, and 29.9% in 2021. Mean annual MSRF treatment rate was 76.9 % with increasing trend from 76.8% in 2010 to 82.8% in 2021. Increasing MSRF screening rate was not realized nor a clear pattern evidenced as guidelines became widely distributed over the 10-year study period. Minority patients had significantly lower odds of having MSRF screening after adjusting for clinical/socio-economic variables.

CONCLUSIONS: Provider education and development/implementation of interventions to optimize adherence to MSRF screening and treatment guidelines are needed to decrease the harmful adverse effects of ADT in PCa patients.