Terrone Carlo, Berruti Alfredo, Papotti Mauro, Vavassori Vittorio, Sciarra Alessandro
Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Novara - Italy.
Medical Oncology Unit, University of Brescia at Spedali Civili Hospital, Brescia - Italy.
Tumori. 2016 Oct 13;102(5):514-520. doi: 10.5301/tj.5000389. Epub 2015 Jun 30.
To assess the opinions of urologists, oncologists and radiation oncologists on the indication for androgen deprivation therapy (ADT) and the definition and management of castration-resistant prostate cancer (CRPC).
In this study using the Delphi method, a list of 15 statements (66 items overall) addressing key issues in ADT and CRPC was sent to 255 participants (urologists, oncologists and radiation oncologists). Responses were rated on a 5-point Likert scale (1=strong disagreement; 5=strong agreement). Disagreement was defined as ≥66% responses with scores 1-2 and agreement as ≥66% responses with scores 3-5. No consensus was absence of agreement/disagreement.
Overall, there was agreement and disagreement in 50% and 15% of the items, respectively. In 71.2% of the items the panelists agreed with each other. The highest concordance rate was observed between urologists and oncologists (87.8%). There were no items with 3 different opinions between the specialists. All panelists agreed on the definition of CRPC. Urologists and oncologists agreed on the recommendation to continue ADT in CRPC. In both nonmetastatic and metastatic asymptomatic CRPC patients with biochemical progression, treatment should be based on PSA kinetics. The panelists agreed on the use of chemotherapy in symptomatic and asymptomatic metastatic CRPC patients but not in those with nonmetastatic CRPC. There was agreement on the timing of initiation of abiraterone and enzalutamide either before or after chemotherapy.
With few exceptions there was agreement among urologists, oncologists and radiation oncologists about the management of CRPC, although the indications were not always in line with international guidelines.
评估泌尿外科医生、肿瘤内科医生和放射肿瘤学家对于雄激素剥夺治疗（ADT）的指征以及去势抵抗性前列腺癌（CRPC）的定义和管理的看法。
在本研究中采用德尔菲法，将一份包含15条陈述（共66项）的关于ADT和CRPC关键问题的清单发送给255名参与者（泌尿外科医生、肿瘤内科医生和放射肿瘤学家）。回答按照5级李克特量表进行评分（1 = 强烈不同意；5 = 强烈同意）。不同意被定义为≥66%的回答得分为1 - 2分，同意被定义为≥66%的回答得分为3 - 5分。无共识定义为不存在同意/不同意的情况。
总体而言，分别有50%和15%的项目存在同意和不同意的情况。在71.2%的项目中，专家小组成员彼此达成了一致。泌尿外科医生和肿瘤内科医生之间的一致性率最高（87.8%）。专家之间不存在有三种不同意见的项目。所有专家小组成员对CRPC的定义达成了一致。泌尿外科医生和肿瘤内科医生对于在CRPC中继续进行ADT的建议达成了一致。在生化进展的非转移性和转移性无症状CRPC患者中，治疗均应基于前列腺特异抗原（PSA）动力学。专家小组成员对于有症状和无症状转移性CRPC患者使用化疗达成了一致，但对于非转移性CRPC患者则未达成一致。对于阿比特龙和恩杂鲁胺在化疗之前或之后开始使用的时机达成了一致。
除少数例外情况外，泌尿外科医生、肿瘤内科医生和放射肿瘤学家在CRPC的管理方面达成了一致，尽管其指征并不总是与国际指南相符。
