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Despite improvements in surgical and radiologic techniques for localized prostate cancer, 20% to 40% of patients who undergo such procedures manifest biochemical disease recurrence, as defined by rising serum prostate-specific antigen (PSA) levels. Many of these patients are treated immediately with androgen-deprivation therapy (ADT). However, this practice is controversial (especially for older men), given concerns about ADT-related toxicity as well as the lack of evidence for benefit from early initiation of ADT.
To determine factors that lead to early ADT initiation, investigators conducted a prospective cohort study of 67 predominantly healthy older men (mean age, 68) who exhibited PSA progression. Physicians who provided treatment were …