title: Diagnosis and treatment for clinically localized prostate cancer. Adherence to the European Association of Urology clinical guidelines in a nationwide population-based study - GESCAP group.
abstract: OBJECTIVE
  To assess the adherence to European Association of Urology (EAU) guidelines in the management of prostate cancer (PCa) in Spain.
  
  
  METHODS
  Epidemiological, population-based, study including a national representative sample of 3,918 incident patients with histopathological confirmation during 2010; 95% of the patient's sample was followed up for at least one year. Diagnosis along with treatment related variables (for localized PCa -low, intermediate, high and locally-advanced by D'Amico risk stratification) was recorded. Differences between groups were tested with Chi-squared and Kruskal-Wallis tests.
  
  
  RESULTS
  Mean (SD) age of PCa patients was 68.48 (8.18). Regarding diagnostic by biopsy procedures, 64.56% of all patients had 8-12 cores in first biopsy and 46.5% of the patients over 75 years, with PSA<10ng/mL were biopsied. Staging by Computer Tomography (CT) or Bone Scan (BS) was used for determining tumor extension in 60.09% of high-risk cases and was applied differentially depending on patients' age; 3,293 (84.05%) patients received a treatment for localized PCa. Radical prostatectomy was done in 1,277 patients and 206 out of these patients also had a lymphadenectomy, being 4.64% low-risk, 22.81% intermediate-risk and 36.00% high-risk patients; 86.08% of 1,082 patients who had radiotherapy were treated with 3D or IMRT and 35.77% received a dose ≥75Gy; 419 patients were treated with brachytherapy (BT): 54.81% were low-risk patients, 22.84% intermediate-risk and 12.98% high-risk. Hormonotherapy (HT, n=521) was applied as single therapy in 9.46% of low-risk and 17.92% of intermediate-risk patients. Additionally, HT was combined with RT in 14.34% of lower-risk patients and 58.26% of high-risk patients, and 67.19% low-intermediate risk with RT and/or BT received neoadjuvant/concomitant/adjuvant HT. Finally, 83.75% of high-risk patients undergoing RT and/or BT also received HT.
  
  
  CONCLUSIONS
  Although EAU guidelines for PCa management are easily available in Europe, the adherence to their recommendations is low, finding the highest discrepancies in the need for a prostate biopsy and the diagnostic methods. Improve information and educational programs could allow a higher adherence to the guidelines and reduce the variability in daily practice. (Controlled-trials.com: ISRCTN19893319).
authors.affiliation: Hospital Universitario de Salamanca-IBSAL-GITUR, Salamanca, España. Electronic address: fgveiga@telefonica.net.
authors.forename: F
authors.initials: F
authors.lastname: Gómez-Veiga
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez-Antolín
authors.affiliation: Hospital Universitario Morales Meseguer, Murcia, España.
authors.forename: B
authors.initials: B
authors.lastname: Miñana
authors.affiliation: Hospital Gregorio Marañón, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Hernández
authors.affiliation: Hospital de Bellvitge, Barcelona, España.
authors.forename: J F
authors.initials: JF
authors.lastname: Suárez
authors.affiliation: Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Fernández-Gómez
authors.affiliation: Hospital Basurto, Bilbao, Vizcaya, España.
authors.forename: M
authors.initials: M
authors.lastname: Unda
authors.affiliation: Hospital Ramón y Cajal, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Burgos
authors.affiliation: Hospital Clínic i Provincial, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Alcaraz
authors.affiliation: Hospital Universitario de Canarias, Santa Cruz de Tenerife, España.
authors.forename: P
authors.initials: P
authors.lastname: Rodríguez
authors.affiliation: Hospital Virgen del Rocío, Sevilla, España.
authors.forename: R
authors.initials: R
authors.lastname: Medina
authors.affiliation: Hospital Virgen Macarena, Sevilla, España.
authors.forename: J
authors.initials: J
authors.lastname: Castiñeiras
authors.affiliation: Medical Department, Astellas Pharma S.A., Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Moreno
authors.affiliation: Medical Department, Astellas Pharma S.A., Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Pedrosa
authors.affiliation: Hospital Virgen de las Nieves, Granada, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Cózar
mesh_terms: D000368:Aged; D005060:Europe; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D012955:Societies, Medical; D013030:Spain; D014572:Urology
keywords: Adherencia a guías clínicas; Diagnosis; Diagnóstico; Disease management; Guideline adherence; Manejo de la enfermedad; Neoplasias de la próstata; Prostatic neoplasms; Tratamiento; Treatment