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Objective  To investigate the treatment of prostate cancer in the United Kingdom. Methods  A postal survey was conducted of consultant urologists and general surgeons with an interest in urology to assess the current patterns of management of patients with prostate cancer in the UK and to determine patterns of clinical practice. Results  Two‐hundred and seventy‐four replies were analysed. Radical radiotherapy (50%) and radical prostatectomy (29%) were the most favoured treatment options for patients <70 years old with poorly differentiated T1 disease; for those aged >70 years, active treatment was favoured by 183 (67%) consultants with radical radiotherapy (37%) and hormonal intervention (29%) the most frequent choices. In well‐differentiated T1 disease, active treatment was favoured by 226 (83%) of consultants for patients <70 years, with radical prostatectomy (44%) the most frequent choice. For patients >70 years, observational management was preferred by 190 (69%) of consultants. In poorly differentiated T1 prostate cancer, active treatment was favoured by 252 (91%) for patients <70, with radiotherapy (50%) the most frequent choice and for patients >70 years, active treatment was favoured by 67% with radical radiotherapy the most common preference being chosen, by 102 (37%). For asymptomatic locally advanced disease, 55% of consultants favoured active treatment, whilst 63% favoured the active treatment of asymptomatic metastatic disease. For patients with symptomatic metastatic disease, GnRH agonist therapy was the treatment of choice of 66% of urologists and was given as monotherapy by 44% or as part of maximal androgen blockade by 22%. In clinical practice, 82% of urologists have close links with oncology, available through joint clinics or on‐site referral. However, <5% of urologists refer patients to an oncologist before the development of hormone refractory disease. At relapse, only 53% of urologists referred their patients to oncologists or palliative‐care clinicians. A wide variety of hormonal treatments was offered at relapse; only 24% of urologists treated their patients by antiandrogen withdrawal or introduction, which is currently the most effective second‐line hormonal treatment for recurrent prostate cancer. Conclusion  There is a wide variation in the clinical management of prostate cancer and we recommend the establishment of standards of practice.

Objective  To investigate the management of urological malignancies in the United Kingdom. Methods  A postal survey of consultant urologists and general surgeons with an interest in urology was conducted to examine current clinical practice in urological malignancies. Results  Completed questionnaires were received from 273 consultant surgeons who saw an estimated total of 13 241 new patients with renal, bladder or testis cancer per year; 82% had access to on‐site oncology services and in general there was a consensus in the answers given. Most respondents advised active treatment of an asymptomatic primary renal cancer in the presence of metastases and a significant proportion of patients with metastases were not prescribed immunotherapy nor were offered a multidisciplinary approach for their condition. Forty‐six per cent of patients with testis cancer received no advice to store sperm before chemotherapy and there were varied opinions as to the need for surgical resection of residual masses after completion of chemotherapy. Conclusion  This survey showed minor variations in the management of renal, bladder and testis tumours in the UK. Consensus management guidelines for urological malignancies and a change in the working relationships between urologists and oncologists is required, to improve the outcome of patients with urological malignancy.

Ultrasound (US) was compared with surgical findings in 98 patients with carcinoma of the ovary undergoing follow-up laparotomy after chemotherapy. US had an overall accuracy of 94% in the pelvis, with only small and sheetlike lesions escaping detection. It was more sensitive than clinical examination. Overall accuracy for the liver was 91% with very few false-positive results. For the peritoneal cavity in general, however, accuracy was low, with even large masses escaping detection. Ascites is reliably detected (accuracy of 97%) but is a poor indicator of peritoneal involvement. US is a useful noninvasive complement to laparoscopy in the follow-up of patients with carcinoma of the ovary.

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