title: Preferences in the management of high-risk prostate cancer among urologists in Europe: results of a web-based survey.
abstract: OBJECTIVE
  To explore preferences in the management of patients with newly diagnosed high-risk prostate cancer (PCa) among urologists in Europe through a web-based survey.
  
  
  METHODS
  A web-based survey was conducted between 15 August and 15 September 2013 by members of the Prostate Cancer Working Group of the Young Academic Urologists Working Party of the European Association of Urology (EAU). A specific, 29-item multiple-choice questionnaire covering the whole spectrum of diagnosis, staging and treatment of high-risk PCa was e-mailed to all urologists included in the mailing list of EAU members. Europe was divided into four geographical regions: Central-Eastern Europe (CEE), Northern Europe (NE), Southern Europe (SE) and Western Europe (WE). Descriptive statistics were used. Differences among sample segments were obtained from a z-test compared with the total sample.
  
  
  RESULTS
  Of the 12,850 invited EAU members, 585 urologists practising in Europe completed the survey. High-risk PCa was defined as serum PSA ≥20 ng/mL or clinical stage ≥ T3 or biopsy Gleason score ≥ 8 by 67% of responders, without significant geographical variations. The preferred single-imaging examinations for staging were bone scan (74%, 81% in WE and 70% in SE; P = 0.02 for both), magnetic resonance imaging (53%, 72% in WE and 40% in SE; P = 0.02 and P = 0.01, respectively) and computed tomography (45%, 60% in SE and 23% in WE; P = 0.01 for both). Pre-treatment predictive tools were routinely used by 62% of the urologists, without significant geographical variations. The preferred treatment was radical prostatectomy as the initial step of a multiple-treatment approach (60%, 40% in NE and 70% in CEE; P = 0.02 and P < 0.01, respectively), followed by external beam radiation therapy with androgen deprivation therapy (29%, 45% in NE and 20% in CEE; P = 0.01 and P = 0.02, respectively), and radical prostatectomy as monotherapy (4%, 7% in WE; P = 0.04). When surgery was performed, the open retropubic approach was the most popular (58%, 74% in CEE, 37% in NE; P < 0.01 for both). Pelvic lymph node dissection was performed by 96% of urologists, equally split between a standard and extended template. There was no consensus on the definition of disease recurrence after primary treatment, and much heterogeneity in the administration of adjuvant and salvage treatments.
  
  
  CONCLUSIONS
  With the limitation of a low response rate, the present study is the first survey evaluating preferences in the management of high-risk PCa among urologists in Europe. Although the definition of high-risk PCa was fairly uniform, wide variations in patterns of primary and adjuvant/salvage treatments were observed. These differences might translate into variations in quality of care with a possible impact on ultimate oncological outcome.
authors.affiliation: Centre of Uronephrology and Renal Transplantation, Fundeni Clinical Institute, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Cristian I
authors.initials: CI
authors.lastname: Surcel
authors.forename: Prasanna
authors.initials: P
authors.lastname: Sooriakumaran
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Pieter J L
authors.initials: PJ
authors.lastname: De Visschere
authors.forename: Jurgen J
authors.initials: JJ
authors.lastname: Fütterer
authors.forename: Pirus
authors.initials: P
authors.lastname: Ghadjar
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Piet
authors.initials: P
authors.lastname: Ost
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.forename: Roderick C N
authors.initials: RC
authors.lastname: van den Bergh
authors.forename: Inge M
authors.initials: IM
authors.lastname: van Oort
authors.forename: Ofer
authors.initials: O
authors.lastname: Yossepowitch
authors.forename: J P Michiel
authors.initials: JP
authors.lastname: Sedelaar
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giannarini
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D003625:Data Collection; D006801:Humans; D020407:Internet; D008297:Male; D009367:Neoplasm Staging; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000628:therapy*; D011878:Radiotherapy
chemical_list: D018931:Antineoplastic Agents, Hormonal
keywords: androgen deprivation therapy; high-risk prostate cancer; prostatectomy; prostatic neoplasms; radiation therapy; survey