Prostate cancer in Spain: from guidelines to clinical practice

Area of Science:

• Urology
• Oncology
• Clinical Practice Guidelines

Background:

• Adherence to established clinical guidelines is crucial for optimal patient outcomes in prostate cancer (PCa).
• The European Association of Urology (EAU) provides comprehensive guidelines for PCa management.
• Assessing current clinical practice against these guidelines is essential for identifying areas of improvement.

Purpose of the Study:

• To evaluate the extent to which current clinical practice in prostate cancer (PCa) aligns with European Association of Urology (EAU) guidelines.
• To identify specific areas within PCa management where adherence to EAU guidelines is low.
• To inform potential revisions and expansions of EAU guidelines based on real-world clinical practice.

Main Methods:

• A multi-phase project involving 242 experts was conducted.
• Controversial topics in PCa were selected, and case descriptions with questionnaires were prepared.
• Face validity was determined, followed by expert completion of questionnaires between November 2007 and January 2008.

Main Results:

• Overall adherence to EAU guidelines for selected controversial PCa topics was 52.1%.
• Low adherence (<40%) was observed in localized PCa for biopsy anesthesia (30.3%), local staging (17.3%), biochemical relapse criteria (32.9%), and post-prostatectomy PSA interpretation (34.4%).
• In metastatic PCa, adherence was low for androgen blockade (34.5%) and hormone reintroduction (21.8%); only 17.4% used the conventional testosterone threshold, and 22.3% agreed on digital rectal exams at each visit.

Conclusions:

• The PROSEO project identified significant discrepancies between clinical practice and EAU guidelines in prostate cancer management.
• These findings highlight areas needing clearer or more specific recommendations within the EAU guidelines.
• The study provides a basis for consolidating and improving EAU guidelines to better reflect and guide current urological practice.