¹Clinical Oncology, Christie Hospital, Manchester, UK

Correspondence: JP Logue, Clinical Oncology, Christie Hospital, Wilmslow Road, Manchester, M20 4BX, UK. E-mail: john.logue@christie-tr.nwest.nhs.uk.

Received 24 February 2005; Revised 16 May 2005; Accepted 30 May 2005; Published online 5 July 2005.

Abstract

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.

Conclusion: There is a wide variation in practice among UK clinicians.