The role of androgen ablation in patients with biochemical or local failure after definitive radiation therapy: A survey of practice patterns of urologists and radiation oncologists in the United States

To identify therapeutic patterns for putative prostate cancer treatment fai lures and the role played by androgen ablation therapy in these patients, a questionnaire study was undertaken with urologists and radiation oncologis ts who had attended a brachytherapy forum at the Seattle Prostate Institute (SPI). Hypothetical questions were asked about recommendations the physici ans would give to a patient demonstrating biochemical or local failure afte r external-beam radiation therapy. Most of the physicians queried were in p rivate practice; 53% were radiation oncologists and 47% were urologists. Th e respondents' recommendations for a hypothetical patient, who was 45 to 65 years of age, with a biopsy-proven local recurrence was treatment with and rogen ablation (35% of respondents), radical prostatectomy (25%), interstit ial brachytherapy (20%), and observation (19%). In the 65- to 75-year-old p atient with a local recurrence, the respondents recommended observation (43 %), androgen ablation (35%), interstitial brachytherapy (17%), and radical prostatectomy (4%). In patients receiving androgen ablation for a biochemic al failure alone, there was no consensus on whether to use luteinizing horm one-releasing hormone agonist alone, total androgen ablation, orchiectomy, or intermittent androgen ablation. Criteria that prompted physicians to ini tiate androgen ablation were based on the rate of prostate-specific antigen (PSA) increase (67%), an absolute PSA number (24%), or clinical failure (9 %). In the younger patient with a local recurrence, local intervention with radical prostatectomy or interstitial brachytherapy was recommended most o ften, followed by androgen ablation, then by observation. In the older pati ent, observation was recommended most often, followed closely by androgen a blation. Overall, there was a lack of consensus on how to deliver androgen ablation. However, there was remarkable agreement between urologists and ra diation oncologists on virtually all issues queried. (C) 2001, Elsevier Sci ence Inc.