Utrecht University, Utrecht, The Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
BJU Int. 2018 Oct;122(4):535-548. doi: 10.1111/bju.14237. Epub 2018 May 1.
Decisions regarding the primary treatment of prostate cancer depend on several patient- and disease-specific factors. Several international guidelines regarding the primary treatment of prostate cancer exist; however, they have not been formally compared. As guidelines often contradict each other, we aimed to systematically compare recommendations regarding the different primary treatment modalities of prostate cancer between guidelines. We searched Medline, the National Guidelines Clearinghouse, the library of the Guidelines International Network, and the websites of major urological associations for prostate cancer treatment guidelines. In total, 14 guidelines from 12 organisations were included in the present article. One of the main discrepancies concerned the definition of 'localised' prostate cancer. Localised prostate cancer was defined as cT1-cT3 in most guidelines; however, this disease stage was defined in other guidelines as cT1-cT2, or as any T-stage as long as there is no lymph node involvement (N0) or metastases (M0). In addition, the risk stratification of localised cancer differed considerably between guidelines. Recommendations regarding radical prostatectomy and hormonal therapy were largely consistent between the guidelines. However, recommendations regarding active surveillance, brachytherapy, and external beam radiotherapy varied, mainly as a result of the inconsistencies in the risk stratification. The differences in year of publication and the methodology (i.e. consensus-based or evidence-based) for developing the guidelines might partly explain the differences in recommendations. It can be assumed that the observed variation in international clinical practice regarding the primary treatment of prostate cancer might be partly due to the inconsistent recommendations in different guidelines.
关于前列腺癌的主要治疗方法的决策取决于几个患者和疾病特异性因素。有几个关于前列腺癌主要治疗的国际指南；然而，它们尚未进行正式比较。由于指南经常相互矛盾，我们旨在系统地比较指南之间关于前列腺癌不同主要治疗方法的建议。我们在 Medline、国家指南清理中心、指南国际网络图书馆以及主要泌尿外科协会的网站上搜索了前列腺癌治疗指南。总共纳入了 12 个组织的 14 个指南。主要差异之一是关于“局限性”前列腺癌的定义。大多数指南将局限性前列腺癌定义为 cT1-cT3；然而，其他指南将该疾病阶段定义为 cT1-cT2，或只要没有淋巴结受累 (N0) 或转移 (M0)，任何 T 阶段均可。此外，局限性癌症的风险分层在指南之间存在很大差异。根治性前列腺切除术和激素治疗的建议在指南之间基本一致。然而，主动监测、近距离放射治疗和外部束放射治疗的建议存在差异，主要是由于风险分层的不一致。发布年份和制定指南的方法（即基于共识或基于证据）的差异可能部分解释了建议的差异。可以假设，国际上前列腺癌主要治疗方法的临床实践存在差异，部分原因是不同指南中的建议不一致。
