Adjuvant and salvage treatment after radical prostatectomy: current practice in the UK.
OBJECTIVE
To survey UK urologists and radiation oncologists in the evaluation and treatment of localised prostate cancer in the adjuvant and salvage setting.


METHODS
Postal questionnaires were mailed to 292 urologists and 98 radiation oncologists in the UK.


RESULTS
In all, 188 (48%) questionnaires were returned. In total, 72/128 (56%) of the urologist respondents and 58/60 (97%) of the oncologist respondents perform routine radical prostate treatment. Among 43 (60%) of the urologist, 40 (69%) recommended adjuvant treatment, which could be radiotherapy, hormonal treatment or combined hormonal and radiation treatment. There is no significant difference between the modality of treatment recommended. The poor prognostic factors that would influence the decision to offer adjuvant treatment include a detectable postoperative PSA, seminal vesicle involvement, positive margins, Gleason score>8 and pathological T3. With regard to the choice of hormonal treatment, most urologists preferred antiandrogens, whereas most oncologists prefer lutienising hormone releasing hormone (LHRH) analogue (P=0.03). Regarding salvage treatment, there is a wide variation in the PSA threshold and number of PSA rises before initiation of investigations and treatment. Significantly more urologists recommended salvage radiotherapy (P=0.02), whereas oncologists recommended combined hormonal radiation therapy (P=0.03). There is a wide variation of practice regarding the duration of hormonal treatment, the type of investigations initiated, range of radiotherapy doses and treatment volumes.


CONCLUSIONS
There is a wide variation in practice among UK clinicians.
Clinical Oncology, Christie Hospital, Manchester, UK.
L W
LW
Lee
N W
NW
Clarke
V A C
VA
Ramani
R A
RA
Cowan
J P
JP
Wylie
J P
JP
Logue
D017024:Chemotherapy, Adjuvant / Q000379:methods*; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D011379:Prognosis; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000601:surgery* / Q000628:therapy*; D011878:Radiotherapy / Q000379:methods; D016879:Salvage Therapy; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom
D007987:Gonadotropin-Releasing Hormone; D017430:Prostate-Specific Antigen