BRITISH UROLOGICAL SURGERY PRACTICE .1. PROSTATE-CANCER

Objective To investigate the treatment of prostate cancer in the Unite d Kingdom. Methods A postal survey was conducted of consultant urologi sts and general surgeons with an interest in urology to assess the cur rent patterns of management of patients with prostate cancer in the UK and to determine patterns of clinical practice. Results Two-hundred a nd seventy-four replies were analysed. Radical radiotherapy (50%) and radical prostatectomy (29%) were the most favoured treatment options f or patients < 70 years old with poorly differentiated TI disease; for those aged > 70 years, active treatment was favoured by 183 (67%) cons ultants with radical radiotherapy (37%) and hormonal intervention (29% ) the most frequent choices. In well-differentiated T1 disease, active treatment was favoured by 226 (83%) of consultants for patients < 70 years, with radical prostatectomy (44%) the most frequent choice. For patients > 70 years, observational management was preferred by 190 (69 %) of consultants. In poorly differentiated TI. prostate cancer, activ e treatment was favoured by 252 (91%) for patients < 70, with radiothe rapy (50%) the most frequent choice and for patients > 70 years, activ e treatment was favoured by 67% with radical radiotherapy the most com mon preference being chosen, by 102 (37%). For asymptomatic locally ad vanced disease, 55% of consultants favoured active treatment, whilst 6 3% favoured the active treatment of asymptomatic metastatic disease. F or patients with symptomatic metastatic disease, GnRH agonist therapy was the treatment of choice of 66% of urologists and was given as mono therapy by 44% or as part of maximal androgen blockade by 22%. In clin ical practice, 82% of urologists have close links with oncology, avail able through joint clinics or on-site referral. However, < 5% of urolo gists refer patients to an oncologist before the development of hormon e refractory disease. At relapse, only 53% of urologists referred thei r patients to oncologists or palliative-care clinicians. A wide variet y of hormonal treatments was offered at relapse; only 24% of urologist s treated their patients by antiandrogen withdrawal or introduction, w hich is currently the most effective second-line hormonal treatment fo r recurrent prostate cancer. Conclusion There is a wide variation in t he clinical management of prostate cancer and we recommend the establi shment of standards of practice.