Department of Clinical Oncology, University College Hospital London, London, UK.
Clin Oncol (R Coll Radiol). 2013 Mar;25(3):178-89. doi: 10.1016/j.clon.2012.09.001. Epub 2012 Oct 15.
Although the National Institute for Health and Clinical Excellence clinical guideline 58 (CG58) for prostate cancer management was expected to have a positive effect, several recommendations raised concern among UK physicians. We conducted a survey of UK oncologists in 2008 and a second, similar survey in 2010 to assess views on these recommendations and to evaluate the change in opinion over time.
Two semi-structured questionnaires were issued by the British Uro-oncology Group to society members in September 2008 and October 2010.
In 2008, 61 UK oncologists completed the survey; 60% agreed that CG58 would make a positive contribution towards improving patient care. There was strong opposition towards active surveillance as the first-line treatment for men with low-risk localised prostate cancer (49% disagreement); implementing 5 yearly flexible sigmoidoscopy post-prostate radiotherapy (51% disagreement); offering follow-up outside of the hospital (e.g. by general practitioners in primary care) for men with a stable prostate-specific antigen for ≥2 years (44% disagreement); and recommendations against docetaxel retreatment (47% disagreement) or bisphosphonate use (58% disagreement). In 2010, 77 UK oncologists completed the survey. The results were largely consistent with 2008, although several recommendations, particularly for localised disease, seem to have promoted a change in clinical practice, suggesting that they are facilitating a standardised approach. Compared with 2008, the 2010 results indicate a shift in favour of active surveillance (80% agreement) and primary care follow-up (59% agreement), but increasing opposition for docetaxel retreatment (57% disagreement). Opinions remained divided for flexible sigmoidoscopy and bisphosphonates.
Despite initial concerns, the CG58 seems to have had a positive impact on prostate cancer management in the UK, with adherence likely facilitating a standardised approach. However, with new data emerging, these findings underscore the need to regularly update guidelines. A revision of the CG58 is anticipated by 2014.
尽管英国国家卫生与临床优化研究所（NICE）关于前列腺癌管理的临床指南 58（CG58）有望产生积极影响，但其中的一些建议引起了英国医生的关注。我们于 2008 年和 2010 年对英国肿瘤学家进行了两次调查，以评估他们对这些建议的看法，并评估随时间推移意见的变化。
2008 年 9 月和 2010 年 10 月，英国泌尿肿瘤学协会通过英国肿瘤学会向社会成员发放了两份半结构式问卷。
2008 年，61 名英国肿瘤学家完成了调查；60%的人认为 CG58 将有助于改善患者的护理。强烈反对主动监测作为低危局限性前列腺癌的一线治疗方法（49%的人不同意）；实施前列腺放疗后 5 年灵活乙状结肠镜检查（51%的人不同意）；对于前列腺特异性抗原稳定≥2 年的男性，在医院外（如初级保健医生）进行随访（44%的人不同意）；反对多西他赛再治疗（47%的人不同意）或双膦酸盐治疗（58%的人不同意）。2010 年，77 名英国肿瘤学家完成了调查。结果与 2008 年基本一致，尽管一些建议，特别是针对局限性疾病的建议，似乎促进了临床实践的改变，表明它们正在促进标准化方法。与 2008 年相比，2010 年的结果表明，人们更倾向于选择主动监测（80%的人同意）和初级保健随访（59%的人同意），但对多西他赛再治疗的反对意见（57%的人不同意）有所增加。对于乙状结肠镜检查和双膦酸盐，意见仍然存在分歧。
尽管最初存在担忧，但 CG58 似乎对英国的前列腺癌管理产生了积极影响，由于遵循该指南，可能促进了标准化方法。然而，随着新数据的出现，这些发现强调了定期更新指南的必要性。预计 2014 年将对 CG58 进行修订。
