title: Prostate cancer in Spain: from guidelines to clinical practice.
abstract: OBJECTIVE
  • To determine how closely practice in prostate cancer (PCa) follows European Association of Urology (EAU) guidelines.
  
  
  METHODS
  • This project involving 242 experts comprised four phases: (1) selection of controversial topics by a panel of experts; (2) preparation of case descriptions and associated questionnaires; (3) determination of their face validity; and (4) completion (November 2007 to January 2008). • The primary endpoint was percentage agreement with the recommendations given by the EAU guidelines. Topics not specifically addressed in these guidelines were also analysed.
  
  
  RESULTS
  • For the selected controversial topics, the overall mean adherence to the guidelines was 52.1%. Topics with a mean adherence <40% are detailed below. • For localized/locally advanced PCa the lowest adherence was found for the type of anaesthesia used during biopsy (30.3%, sd= 14.4), local staging (17.3%, sd= 10.4), new criteria for biochemical relapse after radiotherapy (32.9%, sd= 27.6), and the interpretation of raised PSA after prostatectomy (34.4%, sd= 20.1). • For metastatic PCa, the lowest adherence referred to androgen blockade (34.5%, sd= 24.94) and the reintroduction of hormone therapy (21.8%, sd= 13.5). • Regarding the monitoring of patients, 83.9% of the urologists stated that they measure testosterone levels at some point, and the conventional threshold level of 50 ng/dL testosterone was only used by 17.4%. • Differences in opinion were also observed for the recommendation for a digital rectal examination at each visit (agreed by only 22.3%).
  
  
  CONCLUSIONS
  • The PROSEO project represents an opportunity to consolidate and improve EAU guidelines by identifying issues that, on the basis of clinical practice in PCa and topics of current concern to urologists, have not been fully addressed or might need specific recommendations.
authors.affiliation: Hospital Clínic, IDIBAPS, Barcelona, Madrid, Spain. AALCARAZ@clinic.ub.es
authors.forename: Antonio
authors.initials: A
authors.lastname: Alcaraz
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Burgos
authors.forename: José M
authors.initials: JM
authors.lastname: Cózar
authors.forename: Francisco
authors.initials: F
authors.lastname: Gómez-Veiga
authors.forename: Juan
authors.initials: J
authors.lastname: Morote
authors.forename: Eduardo
authors.initials: E
authors.lastname: Solsona
authors.forename: Miguel
authors.initials: M
authors.lastname: Unda
authors.forename: Joaquín
authors.initials: J
authors.lastname: Carballido
mesh_terms: D019317:Evidence-Based Medicine; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011471:Prostatic Neoplasms / Q000628:therapy*; D013030:Spain