• Castration levels;
  • EAU guidelines;
  • monitoring;
  • prostate cancer;
  • Spain;
  • testosterone

Study Type – Therapy (outcomes research) Level of Evidence 2b

What’s known on the subject? and What does the study add?

To our knowledge, this is the first study which addresses the degree of compliance of Spanish clinical practice with the EAU Guidelines on prostate cancer (PCa).

The study identifies aspects of clinical practice in PCa that diverge from the recommendations in the EAU guidelines, as well as a series of grey areas where specific recommendations are lacking, providing insights for further improvement. The study describes the level of compliance among Spanish urologists.


• To determine how closely practice in prostate cancer (PCa) follows European Association of Urology (EAU) guidelines.


• This project involving 242 experts comprised four phases: (1) selection of controversial topics by a panel of experts; (2) preparation of case descriptions and associated questionnaires; (3) determination of their face validity; and (4) completion (November 2007 to January 2008).

• The primary endpoint was percentage agreement with the recommendations given by the EAU guidelines. Topics not specifically addressed in these guidelines were also analysed.


• For the selected controversial topics, the overall mean adherence to the guidelines was 52.1%. Topics with a mean adherence <40% are detailed below.

• For localized/locally advanced PCa the lowest adherence was found for the type of anaesthesia used during biopsy (30.3%, sd= 14.4), local staging (17.3%, sd= 10.4), new criteria for biochemical relapse after radiotherapy (32.9%, sd= 27.6), and the interpretation of raised PSA after prostatectomy (34.4%, sd= 20.1).

• For metastatic PCa, the lowest adherence referred to androgen blockade (34.5%, sd= 24.94) and the reintroduction of hormone therapy (21.8%, sd= 13.5).

• Regarding the monitoring of patients, 83.9% of the urologists stated that they measure testosterone levels at some point, and the conventional threshold level of 50 ng/dL testosterone was only used by 17.4%.

• Differences in opinion were also observed for the recommendation for a digital rectal examination at each visit (agreed by only 22.3%).


• The PROSEO project represents an opportunity to consolidate and improve EAU guidelines by identifying issues that, on the basis of clinical practice in PCa and topics of current concern to urologists, have not been fully addressed or might need specific recommendations.