APPROPRIATE INDICATIONS FOR PROSTATECTOMY IN THE UK - RESULTS OF A CONSENSUS PANEL

Study objective - The use of formal consensus development to determine appropriate indications for prostatectomy and to identify factors und erlying clinical decisions about appropriateness is described. Design - A nominal group technique was used. Settings - The study took place in an academic research institution. Participants - The panel consiste d of six urologists and three general practitioners. Measurements and main results - The panel identified agreed indications for prostatecto my, expressed in terms of different combinations of type of retention, type and severity of symptoms, and level of comorbidity. Agreement wa s reached for 67% of the indications considered. For acute on chronic retention, surgery is indicated, regardless of symptom severity, if li fe expectancy is greater than one year. For acute or chronic retention , surgery is generally indicated if symptoms are severe, or if symptom s are moderate and life expectancy is greater than five years. For pat ients with neither acute nor chronic retention, surgery is indicated i f symptoms are severe, or if these are moderate and life expectancy is greater than five years. For chronic or acute retention surgery is in appropriate if symptoms are mild and life expectancy is less than one year, or if there is no retention and only mild symptoms. An ''appropr iateness score'' was developed. This confirmed that in general the rat ings were internally consistent, that the panel attached little weight to mild symptoms, that a combination of irritative and obstructive sy mptoms was no more indicative of surgery than obstructive symptoms alo ne, and that the type of symptom was less important than the other fac tors considered. Conclusions - The results provide a basis for populat ion based surveys of the need for prostatectomy.