尿科存在着因证据与实践之间的差距。我们曾针对欧洲泌尿协会 (EAU) 强烈推荐应用高保证度证据对患者体验产生影响，而实践存在差异的指南进行调查。我们选择“不应在前列腺癌手术前进行新辅助雄激素剥夺疗法 (ADT)”这一推荐作为重点调查。在手术前使用 ADT 既不具有临床效果，也不划算，并且会带来严重的副作用。改善执行难题的第一步是要了解其程度。我们并没有获得针对欧洲 ADT 用于前列腺癌手术的实践现状的清晰图片。为了评估欧洲前列腺癌手术前 ADT 的实际使用情况，我们进行了一项观察性横断面研究。我们在多中心国际环境中进行了近期 ADT 实践的回顾性审核。我们采用非概率性有目的取样，旨在在低体量与高体量、学术与社区、公共与私人中心方面进行广泛取样。我们的主要结果是遵循 ADT 推荐的依从性。使用描述性统计和多层模型调查不同因素 (体量、中心类型和资金类型) 下的国家之间的差异。对低风险、中等风险和高风险患者以及局部晚期前列腺癌患者进行分组分析。我们还收集了未遵循推荐的原因。我们在 2017 年 1 月 1 日至 2020 年 5 月 1 日期间，从 31 个国家的 187 家医院中收入了 6598 例前列腺癌患者。总体上，非依从性为 2% (范围为 0-32%)。大多数变异性发生在高风险亚组中，非依从性为 4% (范围为 0-43%)。遵循推荐的原因包括试图改善肿瘤学结果或术前肿瘤特征；由于排队等待手术时间过长而试图控制癌症；以及患者偏好 (在新辅助 ADT 开始后，从放射治疗转向手术，或者感觉副作用难以忍受)。虽然我们有意进行了不同类型医院的大采样，但对指南认识度高的中心的选择偏见是可能的，因此依从率可能被高估。EAU 指南强烈反对在前列腺癌手术前使用 ADT，但一些不符合指南的 ADT 使用仍会造成患者体验的付出和额外的支付者和提供者负担。应该发展不适当术前 ADT 使用的中止策略。有时在患者无法受益的情况下，会在前列腺癌男性中使用雄激素剥夺疗法 (ADT)。ADT 会引起体重增加和情绪变化，并增加心血管疾病、糖尿病和骨质疏松症的风险。指南强烈建议选择手术的男性不要接受 ADT，但还不清楚指南的遵循程度。我们询问了整个欧洲的泌尿科医生，他们在过去几年里如何对待他们的患者。大多数人没有在手术前使用 ADT，但在一些地方仍在使用。需要进行更多研究，帮助医生停止在那些不会从中受益的患者中使用 ADT。版权所有 © 2023 作者。由 Elsevier B.V. 发布。保留所有权利。

Evidence-practice gaps exist in urology. We previously surveyed European Association of Urology (EAU) guidelines for strong recommendations underpinned by high-certainty evidence that impact patient experience for which practice variations were suspected. The recommendation "Do not offer neoadjuvant androgen deprivation therapy (ADT) before surgery for patients with prostate cancer" was prioritised for further investigation. ADT before surgery is neither clinically effective nor cost effective and has serious side effects. The first step in improving implementation problems is to understand their extent. A clear picture of practice regarding ADT before surgery across Europe is not available.To assess current ADT use before prostate cancer surgery in Europe.This was an observational cross-sectional study. We retrospectively audited recent ADT practices in a multicentre international setting. We used nonprobability purposive sampling, aiming for breadth in terms of low- versus high-volume, academic, versus community and public versus private centres.Our primary outcome was adherence to the ADT recommendation. Descriptive statistics and a multilevel model were used to investigate differences between countries across different factors (volume, centre type, and funding type). Subgroup analyses were performed for patients with low, intermediate, and high risk, and for those with locally advanced prostate cancer. We also collected reasons for nonadherence.We included 6598 patients with prostate cancer from 187 hospitals in 31 countries from January 1, 2017 to May 1, 2020. Overall, nonadherence was 2%, (range 0-32%). Most of the variability was found in the high-risk subgroup, for which nonadherence was 4% (range 0-43%). Reasons for nonadherence included attempts to improve oncological outcomes or preoperative tumour parameters; attempts to control the cancer because of long waiting lists; and patient preference (changing one's mind from radiotherapy to surgery after neoadjuvant ADT had commenced or feeling that the side effects were intolerable). Although we purposively sampled for variety within countries (public/private, academic/community, high/low-volume), a selection bias toward centres with awareness of guidelines is possible, so adherence rates may be overestimated.EAU guidelines recommend against ADT use before prostate cancer surgery, yet some guideline-discordant ADT use remains at the cost of patient experience and an additional payer and provider burden. Strategies towards discontinuation of inappropriate preoperative ADT use should be pursued.Androgen deprivation therapy (ADT) is sometimes used in men with prostate cancer who will not benefit from it. ADT causes side effects such as weight gain and emotional changes and increases the risk of cardiovascular disease, diabetes, and osteoporosis. Guidelines strongly recommend that men opting for surgery should not receive ADT, but it is unclear how well the guidance is followed. We asked urologists across Europe how patients in their institutions were treated over the past few years. Most do not use ADT before surgery, but this still happens in some places. More research is needed to help doctors to stop using ADT in patients who will not benefit from it.Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.