(UroToday.com) During the 2025 Society of Urologic Oncology (SUO) Annual Meeting, Dr. Ted Skolarus and colleagues presented findings from Living Well with Prostate Cancer, a multicenter, randomized de-implementation trial designed to reduce the overuse of androgen deprivation therapy (ADT) among men with localized or recurrent non-metastatic prostate cancer.
ADT is frequently overutilized in settings where its benefit is unclear or minimal, exposing patients to avoidable adverse effects such as hot flashes, fatigue, decreased libido, osteoporosis, metabolic disturbances, and cardiovascular morbidity. The study team sought to evaluate two behavioral-theory–informed electronic health record (EHR)–based de-implementation strategies aimed at decreasing inappropriate or unnecessary ADT use across Veterans Affairs (VA) facilities. Their overarching objective was to evaluate whether these approaches could reduce overuse of ADT while also assessing implementation feasibility, reach, and site-level penetration.
Dr. Skolarus and colleagues conducted the 6-month Living Well with Prostate Cancer trial across four intervention sites and four contemporary control sites in the U.S. Veterans Affairs integrated delivery system (March 2023–February 2024).
Intervention sites were randomized to one of two strategies:
- Clinical Reminder Order Check (“Order check”): A real-time EHR reminder prompting clinicians to reconsider ADT for patients with localized/recurrent nonmetastatic cancer and low PSA levels.
- Electronic Health Record Advisory Progress Note (“Advisory progress note: Featuring scripted talking points and a patient educational handout. Clinicians at these sites also received a brief overview session.
Both interventions were grounded in the Behavior Change Wheel and Capability, Opportunity, Motivation–Behavior (COM-B) model and targeted clinicians who prescribe ADT as monotherapy for localized disease or biochemical recurrence without metastasis.
The primary effectiveness outcome was interruption of ADT injections during the 6-month period. Additional implementation outcomes assessed included feasibility, reach, and penetration.
Across intervention (n=4) and control (n=4) sites, the investigators identified 486 cases of potential ADT overuse:
- Order check sites: 105 cases (2 sites)
- Advisory progress note sites: 99 cases (2 sites)
- Control sites: 282 cases (4 sites)
The median patient age was 77 years, with most patients being White (61%) and Black (29%).
Intervention fidelity varied:
- No ADT providers opted out at intervention sites (n=50; 100% reach).
- Three of the four intervention sites successfully deployed and operationalized their assigned strategy (site feasibility 100%).
- One advisory progress note site reached only 79% penetration due to a limited pool of eligible cases.
- The second advisory note site did not successfully launch the intervention due to technical challenges.
During the 6-month intervention period, interruption of ADT occurred in:
- 28% of progress note cases
- 11% of order check cases
- 9% of control site cases (usual care)
These early findings suggest that advisory-style EHR interventions may produce more meaningful changes in clinician behavior than passive order checks, though feasibility and technical deployment remain key barriers.
Dr. Skolarus concluded that this randomized de-implementation trial demonstrates that behavior theory-informed EHR interventions show promise for reducing inappropriate ADT use in prostate cancer care. However, clinic-level feasibility was a barrier at several sites, and variation in intervention launch and monitoring indicates that full participation may require robust local leadership support. Further analyses are ongoing to better understand these preliminary findings and to support sample size estimation for a larger-scale evaluation.
Presented by: Ted Skolarus, MD, MPH, Professor, Department of Urology, University of Chicago, Chicago, IL
Written by: Rashid K. Sayyid, MD, MSc, Assistant Professor, Urologic Oncologist, Department of Urology at The University of Arizona and Banner University Medical Center – Tucson, AZ, @rksayyid on X during the 2025 Society of Urologic Oncology (SUO) Annual Meeting, Phoenix, AZ, December 2nd–5th, 2025