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

To assess the adherence to European Association of Urology (EAU) guidelines in the management of prostate cancer (PCa) in Spain.

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.

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.

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).

Actas urologicas espanolas. 2017 Mar 09 [Epub ahead of print]

F Gómez-Veiga, A Rodríguez-Antolín, B Miñana, C Hernández, J F Suárez, J M Fernández-Gómez, M Unda, J Burgos, A Alcaraz, P Rodríguez, R Medina, J Castiñeiras, C Moreno, E Pedrosa, J M Cózar, GESCAP

Hospital Universitario de Salamanca-IBSAL-GITUR, Salamanca, España. Electronic address: ., Hospital Universitario 12 de Octubre, Madrid, España., Hospital Universitario Morales Meseguer, Murcia, España., Hospital Gregorio Marañón, Madrid, España., Hospital de Bellvitge, Barcelona, España., Hospital Universitario Central de Asturias (HUCA), Oviedo, Asturias, España., Hospital Basurto, Bilbao, Vizcaya, España., Hospital Ramón y Cajal, Madrid, España., Hospital Clínic i Provincial, Barcelona, España., Hospital Universitario de Canarias, Santa Cruz de Tenerife, España., Hospital Virgen del Rocío, Sevilla, España., Hospital Virgen Macarena, Sevilla, España., Medical Department, Astellas Pharma S.A., Madrid, España., Hospital Virgen de las Nieves, Granada, España.

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