EVALUATION AND MANAGEMENT OF MEN WHOSE RADICAL PROSTATECTOMIES FAILED- RESULTS OF AN INTERNATIONAL SURVEY

Objectives. To determine how urologists evaluate and treat men who dev elop recurrent prostate cancer after radical prostatectomy. Methods. S urveys were mailed to 4467 American Urological Association members com prising 3205 U.S. and 1262 non-U.S. urologists randomly selected from a total membership of approximately 12,000. One thousand four hundred sixteen were returned and 1050 (760 U.S. and 290 non-U.S.) surveys wer e evaluable. Results. To evaluate men with an elevated or rising prost ate-specific antigen (PSA) level more than I year after radical prosta tectomy, 98% of respondents use digital rectal examination, 68% use bo ne scan, 54% use transrectal ultrasound with biopsy, 36% use abdominal or pelvic computed tomography scan, 31% use transrectal ultrasound wi thout biopsy, 25% use prostatic acid phosphatase, 11% use monoclonal a ntibody scan, and 5% use abdominal or pelvic magnetic resonance imagin g. Respondents evaluate men with an elevated or rising PSA within 1 ye ar of radical prostatectomy similarly. To treat documented local recur rence, 81% of respondents recommend radiation therapy, 7% recommend or chiectomy or luteinizing hormone-releasing hormone (LHRH) agonists, 6% recommend observation only, and 5% recommend combined androgen ablati on. To treat documented distant recurrence, 50% recommend combined and rogen ablation, 42% recommend orchiectomy or LHRH agonists, and 7% rec ommend observation only. To treat PSA-only recurrence, 54% recommend o bservation only, 16% recommend combined androgen ablation, 15% recomme nd orchiectomy or LHRH agonists, and 13% recommend radiation therapy. Conclusions. The evaluation of men whose radical prostatectomy failed varies among urologists and does not depend on time of recurrence. Rad iation therapy is used by most urologists to treat local recurrence. H ormonal manipulation is used by more than 90% of urologists to treat d istant recurrence. More than 50% of urologists recommend observation f or men with biochemical-only recurrence. (C) 1998, Elsevier Science In c. All rights reserved.