Department of Urology, Yale University, New Haven, CT.
Urology. 2013 Oct;82(4):807-12. doi: 10.1016/j.urology.2013.04.060. Epub 2013 Aug 1.
To assess the treatment recommendations from a nationally representative sample of radiation oncologists and urologists on adjuvant radiotherapy for patients with pathologically advanced prostate cancer after radical prostatectomy.
From a random sample of 1422 physicians (n = 711 radiation oncologists; n = 711 urologists) in the American Medical Association Masterfile, a mail survey queried treatment recommendations for adjuvant radiotherapy that varied by the following pathologic features: extraprostatic extension (pT3a) vs seminal vesicle invasion (pT3b), Gleason 7 vs Gleason 8-10, and margin negative (MN) vs margin positive (MP). Pearson chi-square and multivariable logistic regression were used to test for differences in treatment recommendations by physician specialty.
Response rates for radiation oncologists and urologists were similar (44% vs 46%; P = .42). Radiation oncologists were more likely to recommend adjuvant radiotherapy than urologists for all the varying pathologic scenarios from pT3a, Gleason 7, and MN (42.5% vs 9.7%; adjusted odds ratio [OR]: 7.82, P <.001) to pT3b, Gleason 8-10, and MP disease (94.5% vs 89.1%, adjusted OR: 2.46, P <.001). Compared with radiation oncologists, urologists were more likely to recommend salvage radiotherapy pT3a, Gleason 7, and MN (90.3% vs 57.7%; adjusted OR: 7.72, P <.001) to pT3b, Gleason 8-10, and MP disease (10.9% vs 5.5%; adjusted OR: 2.22, P <.001).
In this national survey, radiation oncologists and urologists have markedly different treatment recommendations for adjuvant and salvage radiotherapy. Patients with adverse pathologic features after radical prostatectomy should consult with both a urologist and radiation oncologist to hear a diversity of opinions to make the most informed decision possible.
评估来自全国代表性样本的放射肿瘤学家和泌尿科医生对根治性前列腺切除术后病理进展前列腺癌患者辅助放疗的治疗建议。
从美国医学协会主文件中随机抽取 1422 名医生（n=711 名放射肿瘤学家；n=711 名泌尿科医生）的样本，通过邮件调查询问辅助放疗的治疗建议，这些建议因以下病理特征而异：前列腺外延伸（pT3a）与精囊侵犯（pT3b）、Gleason 7 与 Gleason 8-10、切缘阴性（MN）与切缘阳性（MP）。采用 Pearson 卡方检验和多变量逻辑回归检验医生专业之间治疗建议的差异。
放射肿瘤学家和泌尿科医生的回复率相似（44%比 46%；P=0.42）。对于所有不同的病理情况，放射肿瘤学家比泌尿科医生更倾向于推荐辅助放疗，包括 pT3a、Gleason 7 和 MN（42.5%比 9.7%；调整后的优势比[OR]：7.82，P<.001）至 pT3b、Gleason 8-10 和 MP 疾病（94.5%比 89.1%，调整后的 OR：2.46，P<.001）。与放射肿瘤学家相比，泌尿科医生更倾向于推荐挽救性放疗 pT3a、Gleason 7 和 MN（90.3%比 57.7%；调整后的 OR：7.72，P<.001）至 pT3b、Gleason 8-10 和 MP 疾病（10.9%比 5.5%；调整后的 OR：2.22，P<.001）。
在这项全国性调查中，放射肿瘤学家和泌尿科医生对辅助和挽救性放疗有明显不同的治疗建议。根治性前列腺切除术后病理不良的患者应咨询泌尿科医生和放射肿瘤学家，听取各种意见，以便做出最明智的决策。
