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Preferences in the management of high‐risk prostate cancer among urologists in E urope: results of a web‐based survey
Author(s) -
Surcel Cristian I.,
Sooriakumaran Prasanna,
Briganti Alberto,
De Visschere Pieter J.L.,
Fütterer Jurgen J.,
Ghadjar Pirus,
Isbarn Hendrik,
Ost Piet,
Ploussard Guillaume,
Bergh Roderick C.N.,
Oort Inge M.,
Yossepowitch Ofer,
Sedelaar J.P. Michiel,
Giannarini Gianluca
Publication year - 2015
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12796
Subject(s) - medicine , prostate cancer , descriptive statistics , prostate , magnetic resonance imaging , urology , family medicine , gynecology , demography , cancer , radiology , statistics , mathematics , sociology
Objective To explore preferences in the management of patients with newly diagnosed high‐risk prostate cancer ( PCa ) among urologists in Europe through a web‐based survey. Materials and Methods A web‐based survey was conducted between 15 A ugust and 15 S eptember 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 PCa was e‐mailed to all urologists included in the mailing list of EAU members. E urope was divided into four geographical regions: C entral‐ E astern E urope ( CEE ), N orthern E urope ( NE ), S outhern E urope ( SE ) and W estern E urope ( WE ). Descriptive statistics were used. Differences among sample segments were obtained from a z‐test compared with the total sample. Results Of the 12 850 invited EAU members, 585 urologists practising in E urope completed the survey. High‐risk PCa 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. The preferred single‐imaging examinations 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 urologists, without significant geographical variations. The preferred treatment was radical prostatectomy as the initial step of a multiple‐treatment approach (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 much heterogeneity in the 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 the management of high‐risk PCa among urologists in E urope. Although the definition of high‐risk PCa 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.