High Risk Prostate Cancer Survey of the EAU Young Academic Urologist Prostate Cancer Group

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2. Please specify the type of hospital in which you practice:

Office/Ambulatory

County hospital

Regional hospital

Tertiary referral hospital

Academic hospital

I do not have clinical practice with prostate cancer

Other (please specify)

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3. Please specify your clinical experience in the field of prostate cancer:

Less than 5 years

Between 5-10 years

More than 10 years

I have no experience

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4. Is there a multidisciplinary oncological team involved in the management of prostate cancer in your hospital?

Yes

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5. If yes, please select the specialists present:

a. Urologist

b. Radiologist

c. Pathologist

d. Radiation Oncologist

e. Medical Oncologist

f. Palliative Care Specialist

If other, please specify:

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6. Please specify how many radical prostatectomies do you perform yearly:

None

Less than 50

Between 50-100

Between 100-200

More than 200

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7. Please specify if MRI is available for preoperative imaging evaluation of prostate cancer in your hospital:

Yes

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8. If yes, please specify the type of MRI :

Standard 1,5 T MRI

3T MRI

MRI with endorectal coil

Multiparametric MRI

If other, please specify:

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9. What type of EBRT is available in your hospital ?

3D-CRT

IMRT

IGRT

EBRT is not available in my hospital

If other, please specify:

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10. In your country, what is the current health care policy regarding the hormonal treatment ?

The urologist prescribes hormonal treatment and does the follow-up

The medical oncologist prescribes hormonal treatment and does the follow-up

The urologist prescribes the hormonal treatment, but the follow-up is done by the medical oncologist

The medical oncologist prescribes the hormonal treatment, but the follow-up is done by the urologist

Both the urologist and the medical oncologist prescribe the hormonal treatment and both do the follow-up

f. If none of the above, please specify what is the health care policy in your country:

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11. What is your definition of high-risk prostate cancer ?

a. Preoperative PSA ≥ 20 ng/ml

b. Clinical stage ≥ T3 at DRE

c. Biopsy Gleason score ≥ 8

d. PSA ≥ 20 ng/ml or clinical stage ≥ T3 or biopsy GS ≥ 8

e. PSA ≥ 20 ng/ml or clinical stage ≥ T2b or biopsy GS ≥ 8

f. PSA velocity > 2 ng/ml/year

g. Nomogram 5-year PFS ≤ 50

h. If none of the above, please enter your definition:

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12. What is your definition of very-high-risk prostate cancer ?

Clinical stage T3b-T4 at DRE

Suspicious lymph node invasion at imaging

Clinical stage T3b-T4 at DRE or suspicious lymph node invasion at imaging

Nomogram 5-year PFS ≤ 50%

e. If none of the above, please enter your definition:

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13. Do you use nomograms to assess the pretreatment risk of patients with prostate cancer

Yes

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14. If yes, please select what nomograms you use?

Partin Tables

D’Amico risk classification

NCCN risk classification

Kattan nomogram

Stephenson nomogram

UCFS-CAPRA score

If other, please specify:

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15. How do you usually stage high-risk prostate cancer with imaging ?

TRUS

MRI

Endorectal MRI

PET

PET/CT

Bone scan

If other, please specify:

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16. What is your current practice regarding the management of high-risk prostate cancer ?

Radical prostatectomy as monotherapy

Radical prostatectomy initially as part of a multimodal treatment

EBRT as monotherapy

EBRT+ hormonal treatment

Hormonal treatment as monotherapy

Watchful waiting and treatment in case of progression/symptoms

If none of the above, please enter your current practice regarding the management of high-risk prostate cancer:

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17. What is your definition of biochemical recurrence after radical prostatectomy ?

Any rise of PSA

Any rise of PSA above ≥0.2 ng/ml confirmed by a second measurement at least 1 week apart

Any rise of PSA above ≥0.2 ng/ml confirmed by a second measurement at least 1 month apart

3 consecutive rises of PSA above ≥0.2 ng/ml

Any rise of PSA above ≥0.4 ng/ml

Any rise >2 ng/ml above the post-prostatectomy nadir value

If none of the above, please specify:

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18. What is your definition of biochemical recurrence after EBRT ?

Any rise of PSA ≥0.2 ng/ml above post-treatment nadir value confirmed by a second measurement at least 1 week apart

Any rise of PSA ≥0.2 ng/ml above post-treatment nadir value confirmed by a second measurement at least 1 month apart

Any rise of PSA ≥0.4 ng/ml above post-treatment nadir value

3 consecutive PSA rises above post-treatment nadir value

Any rise >2 ng/ml above the post-treatment nadir value

If none of the above, please specify:

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19. What is your definition of local recurrence after radical prostatectomy ?

Positive surgical margins

Abnormal DRE findings

Abnormal urethrocistoscopy findings

Abnormal CT findings

Abnormal MRI findings

Abnormal PET findings

Biopsy-proven recurrence only

If none of the above, please specify:

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20. In which cases do you offer adjuvant EBRT after radical prostatectomy ?

Only in the absence of biochemically measurable disease (bNED)

Only if positive surgical margins are present

In the absence of clinically measurable disease (cNED)

Only if lymph node invasion is present

If none of the above, please specify:

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21. When do you offer adjuvant EBRT after radical prostatectomy ?

Immediately after radical prostatectomy

Within 3 months after radical prostatectomy

Within 6 months after radical prostatectomy

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22. In which cases do you offer adjuvant hormonal treatment after radical prostatectomy ?

Only in the absence of biochemically measurable disease (bNED)

Only if positive surgical margins are present

In the absence of clinically measurable disease (cNED)

Only if lymph node invasion is present

If none of the above, please specify:

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23. In which cases do you offer salvage EBRT after radical prostatectomy ?

At any rise of PSA after radical prostatectomy

At any rise of PSA ≥0.2 ng/ml confirmed by a second measurement

At any rise of PSA ≥0.4 ng/ml confirmed by a second measurement

Only after biopsy-proven local recurrence

At PSA velocity > 2 ng/ml/year

If none of the above, please specify:

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24. In which cases do you offer salvage hormonal treatment after radical prostatectomy ?

Biochemical recurrence

Local recurrence

Distant metastases

If other, please specify:

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25. What type of approach do you prefer when performing radical prostatectomy in high risk patients ?

Open retropubic approach

Perineal approach

Laparoscopic approach

Robot-assisted laparoscopic approach

If none of the above, please specify:

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26. Do you preserve the NVB, if technically feasible, in high-risk PC patients?

No, in all cases

Yes, unilaterally

Yes, bilaterally

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27. What template do you use for pelvic lymphadenectomy in patients with high-risk prostate cancer ?

I never perform pelvic lymphadenectomy

I perform pelvic lymphadenectomy only in cases with imaging suspicion of LNI

I perform pelvic lymphadenectomy according to the Briganti nomogram

I remove the external, internal and obturator nodes, bilaterally, in all cases

I remove the external, internal, common iliac and obturator nodes, bilaterally, in all cases

I remove the external, internal, common iliac, obturator and presacral nodes , in all cases

I remove the external, internal, common iliac and obturator nodes, bilaterally, and all the tissue up to the inferior mesenteric artery, in all cases

I remove the external, internal, common iliac and obturator nodes only on the tumor side

I remove the obturator nodes only

I remove only the suspicious tissue on palpation

If none of the above, please specify the template used:

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28. Please specify if you use intraoperative frozen section to prove lymph node invasion:

Yes

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29. If yes, do you abandon the procedure if lymph node invasion is proven?

Yes

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30. Please specify the method of submission of the lymph node tissue to the pathologist:

I send all the tissue from lymphadenectomy en bloc

I send the tissue in packets according to the area of lymph node dissection (ex: external iliac area, obturator fossa, etc)

I divide the tissue according to the side of pelvic lymphadenectomy (left/right), but I do not divide the tissue in packets according to the area of lymph node dissection

I never perform pelvic lymphadenectomy

If other, please specify:

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31. What is the minimal nodal yield required for an accurate pelvic lymphadenectomy in high-risk patients ?

At least 10 nodes

At least 15 nodes

At least 20 nodes

The number is not important, the dissected areas are more important

I do not perform pelvic lymphadenectomy

If none of the above, please specify the number:

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32. Do you have confidence in your pathologist?

Yes, completely

Yes, but in some cases I ask for a second opinion

No, I always ask for a second opinion

I do not have a pathologist; I do analyze the biopsies and prostatectomy specimens myself

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33. Do you personally evaluate the biopsy specimens under microscope?

Yes

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34. If yes, please specify the correlation between the biopsy results and the final Gleason score of the prostatectomy specimen:

Very strong

Strong

Moderate

Weak

Very weak

I don’t know

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* 1. What country are you from ?

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* 2. Please specify the type of hospital in which you practice:

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* 3. Please specify your clinical experience in the field of prostate cancer:

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* 4. Is there a multidisciplinary oncological team involved in the management of prostate cancer in your hospital?

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* 5. If yes, please select the specialists present:

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* 6. Please specify how many radical prostatectomies do you perform yearly:

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* 7. Please specify if MRI is available for preoperative imaging evaluation of prostate cancer in your hospital:

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* 8. If yes, please specify the type of MRI :

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* 9. What type of EBRT is available in your hospital ?

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* 10. In your country, what is the current health care policy regarding the hormonal treatment ?

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* 11. What is your definition of high-risk prostate cancer ?

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* 12. What is your definition of very-high-risk prostate cancer ?

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* 13. Do you use nomograms to assess the pretreatment risk of patients with prostate cancer

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* 14. If yes, please select what nomograms you use?

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* 15. How do you usually stage high-risk prostate cancer with imaging ?

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* 16. What is your current practice regarding the management of high-risk prostate cancer ?

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* 17. What is your definition of biochemical recurrence after radical prostatectomy ?

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* 18. What is your definition of biochemical recurrence after EBRT ?

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* 19. What is your definition of local recurrence after radical prostatectomy ?

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* 20. In which cases do you offer adjuvant EBRT after radical prostatectomy ?

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* 21. When do you offer adjuvant EBRT after radical prostatectomy ?

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* 22. In which cases do you offer adjuvant hormonal treatment after radical prostatectomy ?

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* 23. In which cases do you offer salvage EBRT after radical prostatectomy ?

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* 24. In which cases do you offer salvage hormonal treatment after radical prostatectomy ?

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* 25. What type of approach do you prefer when performing radical prostatectomy in high risk patients ?

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* 26. Do you preserve the NVB, if technically feasible, in high-risk PC patients?

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* 27. What template do you use for pelvic lymphadenectomy in patients with high-risk prostate cancer ?

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* 28. Please specify if you use intraoperative frozen section to prove lymph node invasion:

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* 29. If yes, do you abandon the procedure if lymph node invasion is proven?

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* 30. Please specify the method of submission of the lymph node tissue to the pathologist:

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* 31. What is the minimal nodal yield required for an accurate pelvic lymphadenectomy in high-risk patients ?

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* 32. Do you have confidence in your pathologist?

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* 33. Do you personally evaluate the biopsy specimens under microscope?

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* 34. If yes, please specify the correlation between the biopsy results and the final Gleason score of the prostatectomy specimen:

1. What country are you from ?

2. Please specify the type of hospital in which you practice:

3. Please specify your clinical experience in the field of prostate cancer:

4. Is there a multidisciplinary oncological team involved in the management of prostate cancer in your hospital?

5. If yes, please select the specialists present:

6. Please specify how many radical prostatectomies do you perform yearly:

7. Please specify if MRI is available for preoperative imaging evaluation of prostate cancer in your hospital:

8. If yes, please specify the type of MRI :

9. What type of EBRT is available in your hospital ?

10. In your country, what is the current health care policy regarding the hormonal treatment ?

11. What is your definition of high-risk prostate cancer ?

12. What is your definition of very-high-risk prostate cancer ?

13. Do you use nomograms to assess the pretreatment risk of patients with prostate cancer

14. If yes, please select what nomograms you use?

15. How do you usually stage high-risk prostate cancer with imaging ?

16. What is your current practice regarding the management of high-risk prostate cancer ?

17. What is your definition of biochemical recurrence after radical prostatectomy ?

18. What is your definition of biochemical recurrence after EBRT ?

19. What is your definition of local recurrence after radical prostatectomy ?

20. In which cases do you offer adjuvant EBRT after radical prostatectomy ?

21. When do you offer adjuvant EBRT after radical prostatectomy ?

22. In which cases do you offer adjuvant hormonal treatment after radical prostatectomy ?

23. In which cases do you offer salvage EBRT after radical prostatectomy ?

24. In which cases do you offer salvage hormonal treatment after radical prostatectomy ?

25. What type of approach do you prefer when performing radical prostatectomy in high risk patients ?

26. Do you preserve the NVB, if technically feasible, in high-risk PC patients?

27. What template do you use for pelvic lymphadenectomy in patients with high-risk prostate cancer ?

28. Please specify if you use intraoperative frozen section to prove lymph node invasion:

29. If yes, do you abandon the procedure if lymph node invasion is proven?

30. Please specify the method of submission of the lymph node tissue to the pathologist:

31. What is the minimal nodal yield required for an accurate pelvic lymphadenectomy in high-risk patients ?

32. Do you have confidence in your pathologist?

33. Do you personally evaluate the biopsy specimens under microscope?

34. If yes, please specify the correlation between the biopsy results and the final Gleason score of the prostatectomy specimen: