Call for better prostate cancer guidelines » Health » 24dash.com

Better guidelines are needed to improve the treatment of men with locally advanced prostate cancer, say researchers.

A survey of specialists found that strategies for managing this vulnerable group of patients varied widely across the UK.

There were also differing opinions about the definition of locally advanced prostate cancer (LAPC).

About a third of men diagnosed with prostate cancer have a tumour that has started to break out but not yet spread to other parts of the body.

Taking the right decision is critical for these patients, and can have a major impact on survival.

A number of different approaches can be taken to treat LAPC, involving both oncologists and surgeons.

They include "watchful waiting" - a system of careful monitoring employed when a cancer is progressing slowly - radiotherapy, removal of the prostate gland (radical prostatectomy) and hormone therapy.

The survey, which questioned 155 practising cancer specialists and urologists, found that over half recognised the need for both to share treatment decisions within multi-disciplinary teams.

However, almost as many still expected their own speciality to be solely in charge.

A total of 41% of oncologists and 17% of urologists insisted that they should take primary responsibility.

Although radiotherapy was considered the optimum treatment by most of those questioned, 22% of urologists thought surgery was better.

Most favoured using drugs such as Zoladex that block production of the male hormone testosterone in conjunction with radiotherapy. But there was "significant variation" in the preferred duration of hormone treatment and in the radiotherapy dose.

Oncologist Dr Heather Payne, from University College Hospital London, and urologist David Gillatt, from Southmead Hospital, Bristol, reported their findings in BJU International, the official journal of the British Association of Urological Surgeons.

They wrote: "This survey suggests that there are still wide variations in the management practices for locally advanced prostate cancer in the UK, and between urologists and oncologists.

"Improved consensus guidelines are required."

The survey found that virtually every specialist taking part gave a different definition of locally advanced prostate cancer.

They included different tumour staging combinations, aggressiveness measurements, and other diagnostic signs such as the pre-treatment level of the blood test marker PSA.

"This suggests a need for clearer definitions of LAPC," the authors wrote.

Prostate cancer is the most common male cancer in Britain. Each year 32,000 UK men are diagnosed with the disease, and more than 10,000 die from it.

Chris Hiley, head of policy and research at The Prostate Cancer Charity, said: "This survey quantifies important areas of uncertainty in treatment that have worried doctors and their patients for some time. The lack of consensus reported in this survey is what we'd expect given the lack of good enough evidence that clinicians can draw on, when deciding when and how best to intervene when prostate cancer reaches this stage.

"Although some progress is being made, what men with prostate cancer really need is more research into the treatment of locally advanced prostate cancer to enable doctors to know when, and how best to intervene in order to maximise the treatments' effectiveness and reduce its side effects.

"In the meantime, this survey reminds us of the importance of multi-disciplinary team working and good communication and guidance in the management of locally advanced prostate cancer."

Copyright Press Association 2007