Contemporary management of prostate cancer: a practice survey of Ontario genitourinary radiation oncologists.
OBJECTIVE
To survey radiation oncology practice in the utilization of hormonal and radiation therapy in the primary, adjuvant and salvage treatment of localized prostate cancer.


METHODS
Genitourinary radiation oncologists practicing in Ontario were invited to participate in a practice survey examining staging, hormonal and radiation management, and radiation technique for a variety of common clinical scenarios. Background demographic information was collected on all respondents. The survey consisted of three cases relating to the hormonal/radiation management of low-, intermediate-, and high-risk prostate cancer as well as two adjuvant and one salvage post-prostatectomy scenarios. The survey response rate was 70% (26/37).


RESULTS
Clinicians were more likely to utilize laboratory and imaging studies for staging as the risk categorization increased. Low-risk disease was managed with radiation alone in 26/26 (70 Gy in 65%, 74-79.8 Gy in 35%). Intermediate-risk disease was managed with radiation (70 Gy in 46%, 74-79.8 Gy in 54%) with neoadjuvant hormones in 58%. All respondents managed high-risk disease with adjuvant hormones in addition to radiation therapy (70-71 Gy in 85%, and 76 Gy in 15%). In the pT3a, margin negative (PSA undetectable) scenario, most individuals would not recommend adjuvant radiation (73%). If margins were positive, 30% would still not recommend adjuvant radiation. In the salvage scenario (slowly rising PSA 4 years post-prostatectomy for pT2a close margin disease), all respondents would manage with radiation therapy. Hormones were not routinely recommended in the initial management of the adjuvant and salvage scenarios. Radiation doses utilized for both adjuvant and salvage treatment ranged from 60-70 Gy (median 66 Gy).


CONCLUSIONS
General agreement exists for the management of low- and high-risk disease and in the post-prostatectomy salvage setting. Use of dose-escalation and neoadjuvant hormones in the intermediate-risk setting and use of post-prostatectomy adjuvant radiation in the pT3a scenarios varied among radiation oncologists. Current clinical practice in localized prostate cancer reflects the evolving information in the published medical literature.
Department of Radiation Oncology, London Regional Cancer Centre, London, Ont. N6A 4L6, Canada.
George
G
Rodrigues
David
D
D'Souza
Juanita
J
Crook
Shawn
S
Malone
Jinka
J
Sathya
Gerard
G
Morton
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003625:Data Collection; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009864:Ontario; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D018787:Radiation Oncology / Q000706:statistics & numerical data*; D012307:Risk Factors; D016879:Salvage Therapy; D014572:Urology / Q000706:statistics & numerical data
D018931:Antineoplastic Agents, Hormonal