EDITORIAL COMMENT
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492 NATIONWIDE SURVEY OF PRACTICING UROLOGISTS EDITORIAL COMMENT There exist substantial data showing the lack of decision making value of CT, MRI and bone scans in the staging of newly diagnosed prostate cancer in men whose PSA levels are below 10 ngJml. and whose Gleason sums are 6 or less. Although the authors did not attempt to stratify responses as to the use of these diagnostic staging studies according to PSA or Gleason score, it must be assumed that in any American urologist's current practice the percentage of such patients would be high. Thus, the authors confirm the substantial use of these costly studies, which are of little or no value in such patients. The study also emphasizes the need for further educational efforts directed toward adjusting these practices that are an unnec- essary financial burden on our nation's health care delivery system. The data regarding the evaluation and management of men with benign lower urinary tract symptoms provide good and bad news. The good news is that in the interval of only 3 years since its publication in 1992, nearly two-thirds of the respondents use the quantitative AUA symptom index and that the majority evaluate their patients according to the Agency for Health Care Policy and Research guidelines, which were published only 1 year before in 1994. The bad news is the continued use of upper tract imaging studies and diagnostic cystompy by a small but significant percent- age of urologists despite the Agency for Health Care Policy and Research guidelines not recommending them-another unnecessary and wasteful financial burden on our health resources. Again, mom education is needed. Perhaps the most important issue raised by the authors is the relationship of volumes of surgery to efficacy of outcomes and fie- quency of complications. There currently exist no data establishing this relationship if, in fact, one exists. "rm3urethral resection of the prostate, despite the availability of video monitoring, remains a highly technical procedure with a significant learning curve, esw- cially when resecting large prostate glands. The question can surely be asked in this era of medical and device alternative therapies whether urologists in training and in practice are experiencing suf- ficient volumes of cases to achieve and maintain proficiency. For radical prostatectomy the respondents reported a median of 1 such operation per month, meaning that half were performing less. h e such volumes sufficient? The authors admonish that a study defining this question is needed. I concur. The AUA Prostate Cancer Task Force, possibly working in collaboration with the Prostate Patient Outcomes Re- search Team, may soon be evaluating this question. H. Logan Holtgrewe Conte Building, Suite 200 116 Defense Highway Annapolis, Maryland
Transcript of EDITORIAL COMMENT
492 NATIONWIDE SURVEY OF PRACTICING UROLOGISTS
EDITORIAL COMMENT
There exist substantial data showing the lack of decision making value of CT, MRI and bone scans in the staging of newly diagnosed prostate cancer in men whose PSA levels are below 10 ngJml. and whose Gleason sums are 6 or less. Although the authors did not attempt to stratify responses as to the use of these diagnostic staging studies according to PSA or Gleason score, it must be assumed that in any American urologist's current practice the percentage of such patients would be high. Thus, the authors confirm the substantial use of these costly studies, which are of little or no value in such patients. The study also emphasizes the need for further educational efforts directed toward adjusting these practices that are an unnec- essary financial burden on our nation's health care delivery system.
The data regarding the evaluation and management of men with benign lower urinary tract symptoms provide good and bad news. The good news is that in the interval of only 3 years since its publication in 1992, nearly two-thirds of the respondents use the quantitative AUA symptom index and that the majority evaluate their patients according to the Agency for Health Care Policy and Research guidelines, which were published only 1 year before in 1994. The bad news is the continued use of upper tract imaging studies and diagnostic cystompy by a small but significant percent- age of urologists despite the Agency for Health Care Policy and Research guidelines not recommending them-another unnecessary
and wasteful financial burden on our health resources. Again, mom education is needed.
Perhaps the most important issue raised by the authors is the relationship of volumes of surgery to efficacy of outcomes and fie- quency of complications. There currently exist no data establishing th is relationship if, in fact, one exists. "rm3urethral resection of the prostate, despite the availability of video monitoring, remains a highly technical procedure with a significant learning curve, esw- cially when resecting large prostate glands. The question can surely be asked in this era of medical and device alternative therapies whether urologists in training and in practice are experiencing suf- ficient volumes of cases to achieve and maintain proficiency. For radical prostatectomy the respondents reported a median of 1 such operation per month, meaning that half were performing less. h e such volumes sufficient?
The authors admonish that a study defining this question is needed. I concur. The AUA Prostate Cancer Task Force, possibly working in collaboration with the Prostate Patient Outcomes Re- search Team, may soon be evaluating this question.
H. Logan Holtgrewe Conte Building, Suite 200 116 Defense Highway Annapolis, Maryland
