Preferences between three options for androgen deprivation therapy: a focus group study.

Objectives: Androgen deprivation therapy (ADT) forms the mainstay of treatment for advanced prostate cancer. Traditionally administered as a luteinising hormone-releasing hormone (LHRH) agonist depot injection, newer options for ADT include transdermal oestradiol patches (tE2) or oral LHRH antagonists. This study aimed to identify whether this is an important choice for men, which treatment men would choose if offered either LHRH agonist injections, tE2 patches or oral LHRH antagonists as ADT, and to explore the factors influencing this decision.

Subjects, Patients, And Methods: Five focus groups were conducted. A total of 24 men from around the UK participated in discussions, of whom 10 had never had prostate cancer and 14 had early prostate cancer but had not received ADT. Focus groups were co-facilitated with patient and public involvement representatives. Transcripts were analysed using a critical realist thematic analysis approach.

Results: Participants reported that having a choice of ADT is important and being involved in making treatment decisions can help men maintain an element of control. Most men expressed a preference to avoid ADT with LHRH agonist injections; 14 of the 24 men reported they would choose an oral LHRH antagonist, eight reported they would choose tE2 patches, and two that they would choose LHRH agonist injections. Participants reported a large number of factors that influenced their treatment choice that were grouped into: (i) side-effects of treatment, (ii) logistical aspects, and (iii) advice from trusted others. Personal preferences between different types of ADT were based on factors that participants identified as important to them, this prioritisation of factors was influenced by participants' past experiences, current health beliefs, and future expectations.

Conclusions: Men wish to have choice of ADT, and many would not choose LHRH agonists injections if there were other ADT options available. This should be considered, as reimbursement committees and guideline-makers consider the role of alternative ADT strategies.