Patterns of care for prostate cancer radiotherapy—results from a survey among German-speaking radiation oncologists

Abstract Background Emerging moderately hypofractionated and ultra-hypofractionated schemes for radiotherapy (RT) of prostate cancer (PC) have resulted in various treatment options. The aim of this survey was to evaluate recent patterns of care of German-speaking radiation oncologists for RT of PC. Methods We developed an online survey which we distributed via e‑mail to all registered members of the German Society of Radiation Oncology (DEGRO). The survey was completed by 109 participants between March 3 and April 3, 2020. For evaluation of radiation dose, we used the equivalent dose at fractionation of 2 Gy with α/β = 1.5 Gy, equivalent dose (EQD2 [1.5 Gy]). Results Median EQD2(1.5 Gy) for definitive RT of the prostate is 77.60 Gy (range: 64.49–84.00) with median single doses (SD) of 2.00 Gy (range: 1.80–3.00), while for postoperative RT of the prostate bed, median EQD2(1.5 Gy) is 66.00 Gy (range: 60.00–74.00) with median SD of 2.00 Gy (range: 1.80–2.00). For definitive RT, the pelvic lymph nodes (LNs) are treated in case of suspect findings in imaging (82.6%) and/or according to risk formulas/tables (78.0%). In the postoperative setting, 78.9% use imaging and 78.0% use the postoperative tumor stage for LN irradiation. In the definitive and postoperative situation, LNs are irradiated with a median EQD2(1.5 Gy) of 47.52 Gy with a range of 42.43–66.00 and 41.76–62.79, respectively. Conclusion German-speaking radiation oncologists’ patterns of care for patients with PC are mainly in line with the published data and treatment recommendation guidelines. However, dose prescription is highly heterogenous for RT of the prostate/prostate bed, while the dose to the pelvic LNs is mainly consistent.

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A survey among German-speaking radiation oncologists on PET-based radiotherapy of prostate cancer

Radiation Oncology ◽

10.1186/s13014-021-01811-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Marco M. E. Vogel ◽

Sabrina Dewes ◽

Eva K. Sage ◽

Michal Devecka ◽

Jürgen E. Gschwend ◽

...

Keyword(s):

Prostate Cancer ◽

Online Survey ◽

German Society ◽

Target Volume ◽

Radiation Oncologists ◽

Positron Emission ◽

Median Total Dose ◽

Psma Pet ◽

German Speaking ◽

The Impact

Abstract Background Positron emission tomography-(PET) has evolved as a powerful tool to guide treatment for prostate cancer (PC). The aim of this survey was to evaluate the acceptance and use of PET—especially with prostate-specific membrane antigen (PSMA) targeting tracers—in clinical routine for radiotherapy (RT) and the impact on target volume definition and dose prescription. Methods We developed an online survey, which we distributed via e-mail to members of the German Society of Radiation Oncology (DEGRO). The survey included questions on patterns of care of RT for PC with/without PET. For evaluation of doses we used the equivalent dose at fractionation of 2 Gy with α/β = 1.5 Gy [EQD2(1.5 Gy)]. Results From 109 participants, 78.9% have the possibility to use PET for RT planning. Most centers use PSMA-targeting tracers (98.8%). In 39.5%, PSMA-PET for biochemical relapse after prior surgery is initiated at PSA ≥ 0.5 ng/mL, while 30.2% will perform PET at ≥ 0.2 ng/mL (≥ 1.0 ng/mL: 16.3%, ≥ 2.0 ng/mL: 2.3%, regardless of PSA: 11.7%). In case of PET-positive local recurrence (LR) and pelvic lymph nodes (LNs), 97.7% and 96.5% of the participants will apply an escalated dose. The median total dose in EQD2(1.5 Gy) was 70.00 Gy (range: 56.89–85.71) for LR and 62.00 Gy (range: 52.61–80.00) for LNs. A total number of ≤ 3 (22.0%) or ≤ 5 (20.2%) distant lesions was most often described as applicable for the definition as oligometastatic PC. Conclusion PSMA-PET is widely used among German radiation oncologists. However, specific implications on treatment planning differ among physicians. Therefore, further trials and guidelines for PET-based RT are warranted.

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4: Patterns of Care Among Canadian Radiation Oncologists and Urologists Related to Post-Operative Radiotherapy for Patients with Prostate Cancer

Radiotherapy and Oncology ◽

10.1016/s0167-8140(16)33403-x ◽

2016 ◽

Vol 120 ◽

pp. S2

Author(s):

Bonnie Bristow ◽

Mohammed Aldehaim ◽

Katija Bonin ◽

Chee Ka Candice Lam ◽

Xingshan Cao ◽

...

Keyword(s):

Prostate Cancer ◽

Patterns Of Care ◽

Radiation Oncologists

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PO-1361 Patterns of care for intermediate-risk prostate cancer – results from an online survey

Radiotherapy and Oncology ◽

10.1016/s0167-8140(21)07812-9 ◽

2021 ◽

Vol 161 ◽

pp. S1116-S1117

Author(s):

V. Mareco ◽

M.C.D. Silva ◽

A.N. Abrunhosa-Branquinho ◽

J. Pisco ◽

S. Saraiva ◽

...

Keyword(s):

Prostate Cancer ◽

Online Survey ◽

Patterns Of Care ◽

Intermediate Risk ◽

Risk Prostate Cancer

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Patterns of prostate cancer management across Canadian prostate cancer treatment specialists.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.321 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 321-321

Author(s):

Bobby Shayegan ◽

Alan I. So ◽

Shawn Malone ◽

Sebastien J. Hotte ◽

Antonio Finelli ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Treatment ◽

Advanced Prostate Cancer ◽

Patterns Of Care ◽

Online Questionnaire ◽

Prostate Cancer Treatment ◽

Chi Square ◽

Cancer Management ◽

Radiation Oncologists ◽

Medical Oncologists

321 Background: The Canadian GU Research Consortium (GURC) was recently established to bring comprehensive prostate cancer centres together to collaborate on research, education, and adoption of best practices. As an initial step to inform the work of the GURC, an electronic questionnaire was designed to assess management of advanced prostate cancer care in Canada and better understand patterns of care. Methods: A 59-item online questionnaire was developed by a multidisciplinary scientific committee to measure physician practices, patterns of care, treatment sequencing, and management of mCRPC. After pre-testing, the online questionnaire was sent to 93 urologists, uro-oncologists, medical oncologists, radiation oncologists, and general practitioner oncologists who are actively involved in the treatment of prostate cancer. Results: A total of 49 (53%) respondents completed the questionnaire between April 17, 2017 to May 17, 2017. Although all respondents indicated a role in initiating life-prolonging oral therapy for mCRPC and monitoring treatment and side effects, chemotherapy initiation was mainly a medical oncologist role compared to other specialties (p < 0.05, chi-square). Symptom management such as palliative care and end-of-life care were provided mainly by radiation oncologists (100%) and medical oncologists (81%) compared to urologists (33%) and uro-oncologists (50%), p < 0.05, chi-square). Patient mix varied across the disciplines. Urologist practices were composed primarily of non-metastatic prostate cancer patients (73%), as were radiation oncologist practices (77%), while uro-oncologist practices included both non-metastatic (58%) and metastatic (40%) patients. Medical oncologists practices were mainly (91%) metastatic patients. Referral patterns also varied by discipline. Conclusions: In Canada, prostate cancer treatment involves multiple disciplines providing a range of care at different points across the treatment continuum. We plan to do further research to better understand variation in practice and improve multidisciplinary coordination for patients with advanced prostate cancer.

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Nutrition services for men with prostate cancer: A health professional survey.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.7_suppl.25 ◽

2018 ◽

Vol 36 (7_suppl) ◽

pp. 25-25

Author(s):

Kaity McLaughlin ◽

Lindsay Hedden ◽

Phil Pollock ◽

Celestia S. Higano ◽

Rachel A Murphy

Keyword(s):

Prostate Cancer ◽

Health Care Professionals ◽

Online Survey ◽

Unmet Need ◽

Nutrition Support ◽

Registered Dietitians ◽

Nutrition Services ◽

Radiation Oncologists ◽

Medical Oncologists ◽

Nutrition Service

25 Background: Nutrition is a key part of prostate cancer (PC) survivorship for management of PC, treatment side effects, and overall health. The Prostate Cancer Supportive Care (PCSC) Program is one of only a few PC survivorship programs in Canada that provide nutrition support as part of standard care. A survey was conducted as part of a broader needs assessment to understand health care professionals’ (HCPs) perspectives on nutrition services for men with PC and inform nutrition programs. Methods: An online survey was administered to British Columbia (BC) HCPs caring for men with PC including urologists, radiation oncologists, medical oncologists, registered dietitians and researchers. We used purposive sampling to identify relevant HCPs. HCPs were asked about the importance of oncological nutrition services and how they should be delivered to men with PC. We summarized the percent agreement for each question and across professions then thematically analyzed qualitative data. Results: Of the 56 HCPs invited to participate in the survey, 38 (68%) responded. The majority (61%) agreed that men with PC require more nutritional support. HCPs indicated nutrition services should be offered multiple times throughout survivorship and facilitated through online resources, individual consultations with registered dietitians and consecutive group education sessions. Most (75%) urologists, radiation oncologists and medical oncologists responded that weight management should be the focus for nutrition services, whereas 90% of dietitians responded that nutrition for reducing the risk of PC progression should be the focus. The main themes that arose from the survey suggested that nutrition services should be available in different forms to facilitate individual needs and adapted based on cultural and community settings. Conclusions: HCPs confirm that there is an unmet need for nutrition services for men with PC in BC as existing services prioritize and offer services for cancer-related weight loss. Special consideration should be given to the focus of nutrition service provided, and when and how it is offered. These results will inform the development of additional resources for men with PC to support their nutritional needs.

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National survey of advanced prostate cancer patients reveals disparity between perceptions and reality of treatment

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.8590 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 8590-8590

Author(s):

T. N. Kirk ◽

M. A. Moyad

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Online Survey ◽

Treatment Options ◽

Additional Treatment ◽

Hormone Refractory ◽

Strongly Agree ◽

Additional Education ◽

The Impact

8590 Background: Over 50,000 men developed hormone refractory prostate cancer (HRPC) in 2005 (CancerMetrics 2005). The objective of this analysis is to understand patient attitudes towards advancing prostate cancer (PC) and treatment. Methods: Patients were recruited from NexCura’s database of users and links from PC websites: UsTOO, PCRI, PCF and PAACT. Board certified physicians who treat HRPC were recruited by J. Reckner & Assoc. Responses were collected via online survey and analyzed by TSC, a division of Yankelovich. Grant funding from Abbott. The scale was “agree”, strongly agree”, “disagree” or “strongly disagree.” Results: 409 HRPC patients (P), 236 caregivers (C), 100 urologists (U) and 104 oncologists (O) participated. 45% of patients have metastatic HRPC. Mean patient age was 65.7 and age at diagnosis was 60.2. Conclusions: Many patients and caregivers have difficulty with advancing PC. Respondents recognize the survival benefit associated with chemotherapy, but attitude on its impact on quality of life varies significantly. Disparity exists between patients, caregivers and physicians on the impact of treatment on quality of life. Additional education, enhanced dialogue and additional treatment options are needed for HRPC patients, caregivers and physicians. [Table: see text] [Table: see text]

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Results of an online survey of physical, emotional, and practical concerns for prostate cancer survivors in the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.75 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 75-75

Author(s):

Oussama M. Darwish ◽

Prajakta Adsul ◽

Sameer Siddiqui

Keyword(s):

Prostate Cancer ◽

Cancer Survivors ◽

Online Survey ◽

Treatment Options ◽

The United States ◽

Fear Of Cancer Recurrence ◽

Cancer Genes ◽

Prostate Cancer Survivors ◽

Treatment Type ◽

Patient Concerns

75 Background: Prostate cancer survivors face numerous health concerns after treatment. The type of treatment received may have a significant impact on the physical, emotional and practical concerns of the patient. Methods: We analyzed self-reported data from the 2010 LIVESTRONG survey for people affected by prostate cancer. Survey questions were divided into 3 sections including physical, emotional, and practical concerns in the survivorship period. Survey was administered online between June 20, 2010 and March 31, 2011 on the LIVESTRONG.org website. Results: Of the 12,307 respondents, 281 males were included in the analysis based on a primary diagnosis of prostate cancer and US residency status. Mean age was 60 years (range, 41-94) and the majority were white men (90%). The 3 most common physical concerns were decrease in sexual function (70%), urinary frequency (54%) and fatigue (35%). The leading emotional concerns were fear of cancer recurrence (61%), grief about death of other cancer patients (52%) and worry about cancer genes in family members (51%). Practical concerns were cost beyond insurance coverage (90%), financial debt (40%), and inability to continue previous work (6%). One way ANOVA was conducted to detect differences in number of physical, emotional and practical concerns across types of treatment received (surgery, radiation, hormonal and combination). Significant differences were seen in number of physical (p=0.02), emotional (p=0.04) and practical (p<0.001) concerns for patients receiving different treatments (Table 1). Patient concerns also varied based on length of follow-up after treatment. Conclusions: Based on treatment type, hormonal patients have the greatest physical and emotional concerns compared to other treatment options, while surgery patients demonstrate the most practical concerns. The results of the survey illuminate the principal physical, emotional and practical concerns of prostate cancer survivors, and can assist in prioritizing and addressing major patient concerns after prostate cancer treatment.

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Does a community cancer center one-day prostate cancer multidisciplinary clinic result in a change in treatment recommendation?

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.82 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 82-82

Author(s):

Taylor Reid Cushman ◽

Joseph W Mashni ◽

Rachit Kumar

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Treatment Options ◽

Retrospective Chart Review ◽

Treatment Recommendations ◽

Treatment Recommendation ◽

Cancer Center ◽

Risk Category ◽

Stereotactic Radiation ◽

Cancer Multiple

82 Background: Multi-disciplinary clinics (MDCs) offer patients the opportunity to meet with multiple providers to discuss treatment options for recently diagnosed prostate cancer. Multiple academic centers have published their experience with these clinics. However, this approach has been sparsely reported in the community setting. Herein, we assess if an MDC results in more appropriate treatment recommendations for patients based on NCCN risk category compared to incoming (non-MDC) treatment recommendations. Methods: A retrospective chart review of patients evaluated in the institutional prostate cancer MDC clinic were reviewed over a 22 month period (January 2015 through October 2016). A single urologist and radiation oncologist served as clinic consultants for all patients. Patients were asked to report the recommendation for treatment prior to evaluation in the MDC clinic, and the patient selection for treatment after evaluation in the MDC clinic. Changes in treatment recommendation were recorded based on NCCN risk category (low [LR], intermediate [IR], and high [HR] risk groups). Results: Eighty patients were evaluated in the MDC. Of the 80 patients, 64 (80%) chose to continue care with the providers in the prostate MDC. Evaluable records (i.e. initial treatment recommendations) were available for 46 of the 64 patients (72%). Median age of the evaluable patients was 67 years (range 43-83). By risk category, 15 (33%) were LR, 21 (46%) were IR, and 10 (22%) were HR. Eleven patients in the LR group (73%) had altered treatment recommendations, 82% of whom were changed from any treatment (surgery or radiation) to active surveillance. Ten patients in the IR group (48%) and four patients in the HR group (40%) had altered treatment recommendations, mostly from surgery to radiation +/- ADT (50% in the IR, and 75% in the HR group). For all patients seen in the MDC, eight (10%) enrolled on a clinical trial (prostate stereotactic radiation). Conclusions: Implementation of a community-based, one-day prostate MDC resulted in significant changes in treatment recommendations, particularly in increasing active surveillance for LR patients and reducing surgical intervention in IR and HR patients.

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