Prostate cancer in Spain: from guidelines to clinical practice

Abstract

Study Type – Therapy (outcomes research) Level of Evidence 2b What’s known on the subject? and What does the study add? To our knowledge, this is the first study which addresses the degree of compliance of Spanish clinical practice with the EAU Guidelines on prostate cancer (PCa). The study identifies aspects of clinical practice in PCa that diverge from the recommendations in the EAU guidelines, as well as a series of grey areas where specific recommendations are lacking, providing insights for further improvement. The study describes the level of compliance among Spanish urologists. OBJECTIVE • To determine how closely practice in prostate cancer (PCa) follows European Association of Urology (EAU) guidelines. MATERIALS AND METHODS • This project involving 242 experts comprised four phases: (1) selection of controversial topics by a panel of experts; (2) preparation of case descriptions and associated questionnaires; (3) determination of their face validity; and (4) completion (November 2007 to January 2008). • The primary endpoint was percentage agreement with the recommendations given by the EAU guidelines. Topics not specifically addressed in these guidelines were also analysed. RESULTS • For the selected controversial topics, the overall mean adherence to the guidelines was 52.1%. Topics with a mean adherence <40% are detailed below. • For localized/locally advanced PCa the lowest adherence was found for the type of anaesthesia used during biopsy (30.3%, sd= 14.4), local staging (17.3%, sd= 10.4), new criteria for biochemical relapse after radiotherapy (32.9%, sd= 27.6), and the interpretation of raised PSA after prostatectomy (34.4%, sd= 20.1). • For metastatic PCa, the lowest adherence referred to androgen blockade (34.5%, sd= 24.94) and the reintroduction of hormone therapy (21.8%, sd= 13.5). • Regarding the monitoring of patients, 83.9% of the urologists stated that they measure testosterone levels at some point, and the conventional threshold level of 50 ng/dL testosterone was only used by 17.4%. • Differences in opinion were also observed for the recommendation for a digital rectal examination at each visit (agreed by only 22.3%). CONCLUSION • The PROSEO project represents an opportunity to consolidate and improve EAU guidelines by identifying issues that, on the basis of clinical practice in PCa and topics of current concern to urologists, have not been fully addressed or might need specific recommendations.

Population‐based estimate of the use of intermittent androgen deprivation therapy in prostate cancer patients in Catalonia, Spain

“…Our data show that only one‐fourth of physicians included in this study prescribed an IAD scheme at least once, a finding that is consistent with the percentage (21.1%) reported in a survey of 242 Spanish urologists (although that survey only asked about IAD in metastatic disease) . Several reasons could account for the low use of IAD regimens among physicians, including (1) lack of awareness of the recommendations for this approach in clinical guidelines; (2) fear of negatively impacting patient prognosis; (3) lack of familiarity in managing an intermittent regimen; (4) failure to involve patients in selecting the most appropriate treatment; and (5) potential conflicts of interest.…”

Prostate cancer incidence and newly diagnosed patient profile in Spain in 2010

“…Finally, the results on the practice of indications and biopsy methods refl ect a good adaptation to current European PCa guideline recommendations [ 23,24 ] .…”

Patterns of prescription and adherence to European Association of Urology guidelines on androgen deprivation therapy in prostate cancer: an Italian multicentre cross‐sectional analysis from the Choosing Treatment for Prostate Cancer (CHOICE) study

“…In the Programas de Servicio Uro‐oncológico (PROSEO) study, the mean overall concordance with the guidelines was 52.1% and, in relation to disease monitoring, 83.9% of urologists stated that they measured testosterone levels at some point. Of those, 53.3% did so only if biochemical progression was apparent and 17.8% did so at each control visit .…”