Tesis

The Pattern of Prostate Cancer Screening and Diagnosis among Indonesian Urologists: A Questionnaire Survey = Pola Penapisan dan Diagnosis Kanker Prostat oleh Spesialis Urologi di Indonesia: Survey Kuesioner.

Background: Prostate cancer (PCa) screening and diagnosis are mandatory to deliver optimal management in the early phase. Even though it has been discussed in many guidelines, the implementation of PCa screening and diagnosis in Indonesia remains unknown. This study aims to evaluate the pattern of PCa screening and diagnosis among Indonesian urologists and their adherence to guidelines. Methods: This cross-sectional study was conducted between February and July 2019. Respondents were Indonesian urologists registered as members of the Indonesian Urological Association (IUA) and had already practiced for at least six months. Data were collected using questionnaires, which were distributed at a national urology symposium and electronically via Google Form. Data were presented descriptively, and all data were processed using SPSS version 23. Result: Of 458 urologists, 195 (42.6%) gave full responses. Most of the respondents, 181 (92.8%) urologists, used the IUA guidelines. Among the 103 (52.8%) respondents who performed screening, nearly half (42.7%) agreed to screen patients aged ≥ 50 years or ≥ 45 years with a family history of PCa. Moreover, 76.8% would repeat screening annually, and 35.6% would stop when the patient's age reached 70 years old. Digital rectal examination (DRE) was frequently performed for screening (74.5%), while prostate-specific antigen (PSA) tests were only performed in 52.3% of cases. The PSA test was available in 74.8% of hospitals. Transurethral resection of the prostate (TURP) was still used by 67.2% of respondents for diagnosis. Only 52.3 % of participants used transrectal prostate biopsy for diagnosis, using anesthesia (78.1%) during the procedure, and increased PSA level (98%) as its indication. However, Transrectal Ultrasound (TRUS) was only available in 49% of hospitals. This study found that Indonesian urologist adherence level toward guidelines was 63.3% (9-100%). Conclusion: PCa screening and diagnosis are still varied among Indonesian urologists, which might arise due to the different availability of diagnostic modalities.
Keywords: diagnosis, prostate cancer, questionnaire, screening


Latar Belakang: Pemeriksaan dan diagnosis kanker prostat (PCa) diperlukan untuk memberikan manajemen optimal pada tahap awal. Meskipun telah dibahas dalam banyak pedoman, implementasi pemeriksaan dan diagnosis PCa di Indonesia masih belum diketahui. Studi ini bertujuan untuk mengevaluasi pola pemeriksaan dan diagnosis PCa di antara urolog Indonesia serta kepatuhan mereka terhadap pedoman. Metode: Studi potong lintang ini dilakukan antara Februari dan Juli 2019. Responden adalah urolog Indonesia yang terdaftar sebagai anggota Perhimpunan Urologi Indonesia (IUA) dan telah berpraktik selama setidaknya enam bulan. Data dikumpulkan menggunakan kuesioner yang dibagikan dalam simposium urologi nasional dan secara elektronik melalui Google Form. Data disajikan secara deskriptif, dan semua data diproses menggunakan SPSS versi 23. Hasil: Dari 458 urolog, 195 (42,6%) memberikan respons lengkap. Sebagian besar responden, 181 (92,8%) urolog, menggunakan pedoman IUA. Di antara 103 (52,8%) responden yang melakukan pemeriksaan, hampir separuh (42,7%) setuju untuk memeriksa pasien yang berusia ≥ 50 tahun atau ≥ 45 tahun dengan riwayat keluarga PCa. Selain itu, 76,8% akan mengulang pemeriksaan setiap tahun, dan 35,6% akan menghentikannya ketika pasien berusia 70 tahun. Pemeriksaan rektal digital (DRE) sering dilakukan untuk pemeriksaan (74,5%), sementara tes antigen spesifik prostat (PSA) hanya dilakukan dalam 52,3% kasus. Tes PSA tersedia di 74,8% rumah sakit. Reseksi transuretral prostat (TURP) masih digunakan oleh 67,2% responden untuk diagnosis. Hanya 52,3% peserta yang menggunakan biopsi prostat transrektal untuk diagnosis, menggunakan anestesi (78,1%) selama prosedur, dan peningkatan kadar PSA (98%) sebagai indikasi. Namun, USG Transrektal (TRUS) hanya tersedia di 49% rumah sakit. Studi ini menemukan bahwa tingkat kepatuhan urolog Indonesia terhadap pedoman adalah 63,3% (9- 100%). Kesimpulan: Pemeriksaan dan diagnosis PCa masih bervariasi di antara urolog Indonesia, yang mungkin disebabkan oleh ketersediaan modalitas diagnostik yang berbeda.
Kata kunci: diagnosis, kanker prostat, kuesioner, penapisan