Introduction: Adding novel secondary hormone therapy to standard luteinizing hormone therapy is a Category 1 recommendation for treating metastatic castrate-sensitive prostate cancer (mCSPC), non-metastatic castrate-resistant prostate cancer (M0 CRPC), and metastatic castrate-resistant prostate cancer (M1 CRPC) set forth by the National Comprehensive Cancer Network (NCCN). Secondary hormone therapy is a Category 2A recommendation for treating high-risk localized prostate cancer (N0M0 PC), lymph node positive non-metastatic prostate cancer (N1M0 PC), and recurrent non-metastatic prostate cancer. The purpose of this study is part of a quality initiative to evaluate compliance in our academic practice with NCCN guidelines to optimize therapy. Methods: This is a retrospective chart review of all patients receiving leuprolide for androgen deprivation therapy (ADT) from 2021 through June 2022. Patients with intermediate risk prostate cancer on leuprolide were excluded from the study. The number of patients within each category receiving novel secondary hormone therapies was quantified. Results: Overall, of 139 patients who met our criteria, 29% received novel secondary hormone therapy. Compliance with NCCN Category 1 recommendations in terms of novel secondary hormone therapy was 68% overall, including 62% for mCSPC patients, 83% for M0 CRPC patients, and 70% for M1 CRPC. Compliance with Category 2A recommendations for adding novel hormone therapy was 16% overall. When we examined the compliance for individual practitioners, the compliance for the 5 highest-volume urologists ranged from 26-50% overall and 45-100% for Category 1 recommendations. Conclusions: Our findings demonstrate relatively low compliance with Category 1 and 2A recommendations for adding novel secondary hormone therapy in patients with advanced prostate cancer. There is an opportunity to immediately optimize treatment for these patients and future patients with quality improvement initiatives. SOURCE OF Funding: None.
