OBJECTIVE: To explore preferences in management of patients with newly diagnosed high-risk prostate cancer among urologists in Europe through a web-based survey.
MATERIALS AND METHODS: A web-based survey was conducted between August 15 and September 15, 2013 by members of the Prostate Cancer Working Group of the Young Academic Urologists Working Party of the European Association of Urology (EAU). A specific, 29-item multiple-choice questionnaire covering the whole spectrum of diagnosis, staging and treatment of high-risk prostate cancer was e-mailed to all physicians included in the mailing list of EAU members. Europe was divided into four geographical regions: Central-Eastern (CEE), Northern (NE), Southern (SE) and Western (WE). Descriptive statistics were used. Differences among sample segments were obtained from z test compared to total sample.
RESULTS: Of the 12,850 invited EAU-members, 585 urologists practicing in Europe completed the survey. High-risk prostate cancer was defined as serum PSA ≥20 ng/ml or clinical stage≥T3 or biopsy Gleason score ≥8 by 67% of responders, without significant geographical variations. Preferred single imaging exams for staging were bone scan (74%, 81% in WE and 70% in SE, p=0.02 for both), magnetic resonance imaging (53%, 72% in WE and 40% in SE, p=0.02 and p=0.01, respectively) and computed tomography (45%, 60% in SE and 23% in WE, p=0.01 for both). Pre-treatment predictive tools were routinely used by 62% of the physicians, without significant geographical variations. Preferred treatment was radical prostatectomy as the initial step of a multimodal treatment (60%, 40% in NE and 70% in CEE, p=0.02 and p< 0.01, respectively), followed by external beam radiation therapy with androgen deprivation therapy (29%, 45% in NE and 20% in CEE, p=0.01 and p=0.02, respectively), and radical prostatectomy as monotherapy (4%, 7% in WE, p=0.04). When surgery was performed, the open retropubic approach was the most popular (58%, 74% in CEE, 37% in NE, p< 0.01 for both). Pelvic lymph node dissection was performed by 96% of urologists, equally split between a standard and extended template. There was no consensus on the definition of disease recurrence after primary treatment, and ample heterogeneity in administration of adjuvant and salvage treatments.
CONCLUSION: With the limitation of a low response rate, the present study is the first survey evaluating preferences in management of high-risk prostate cancer among urologists in Europe. Although definition of high-risk prostate cancer was fairly uniform, wide variations in patterns of primary and adjuvant/salvage treatments were observed. These differences might translate into variations in quality of care with a possible impact on ultimate oncological outcome.
Written by:
Surcel CI, Sooriakumaran P, Briganti A, De Visschere PJ, Fütterer JJ, Ghadjar P, Isbarn H, Ost P, Ploussard G, van den Bergh RC, van Oort IM, Yossepowitch O, Sedelaar JP, Giannarini G. Are you the author?
Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
Reference: BJU Int. 2014 May 6. Epub ahead of print.
doi: 10.1111/bju.12796
PubMed Abstract
PMID: 24802335
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