| Which imaging method is indicated for a castration- resistant patient with biochemical recurrence after… |
a) PET-CT with PSMA (or PET-MRI with PSMA) +/− pelvic MRI |
b) Whole body MRI |
c) Bone Scan |
d) Pelvic MRI |
e) Pelvic MRI and Bone Scan |
f) CT of the Thorax or Chest-X-Ray, CT of the abdomen and pelvis (or pelvic MRI) and Bone Scan |
g) None |
| 1 |
Radical prostatectomy? |
14 (50%) |
–– |
–– |
–– |
2 (8.3%) |
12 (41.7%) |
–– |
| 2 |
Curatively intended radiotherapy? |
15 (52%) |
–– |
–– |
–– |
–– |
13 (48%) |
–– |
| 3 |
What is your preferred methodology for calculating PSA doubling time (dT)? |
|
a) I do not calculate PSA dT |
b) Last two values (>0.1) using a manual tool |
c) Last two values (>0.1) using an electronic calculator |
d) Last three values (>0.1) using a manual tool |
e) Last three values (>0.1) using an electronic calculator |
f) At least four values (>0.1) using a manual tool |
g) At least four values (>0.1) using an electronic calculator |
|
–– |
–– |
1 (4.2%) |
4 (12.5%) |
18 (66.7%) |
1 (4.2%) |
4 (12.5%) |
| 2. TREATMENT |
| What is your management of M0 CRPC in the majority of men with a life expectancy > 10-15 years and with… |
a) Apalutamide or Enzalutamide |
b) Apalutamide |
c) Enzalutamide |
d) Bicalutamide or Flutamide |
e) Docetaxel |
f) I would not start any specific systemic therapy until the development of clinical metastases |
| 4 |
PSADT ≤ 10 months and PSA ≥ 2ng/mL? |
27 (96.2%) |
1 (3.9%) |
–– |
–– |
–– |
–– |
| 5 |
PSADT ≤ 10 months and PSA < 2ng/mL? |
24 (84%) |
2 (8%) |
–– |
1 (4%) |
–– |
1 (4%) |
| 6 |
PSADT > 10 months and PSA ≥ 2ng/mL? |
–– |
–– |
–– |
1 (3.9%) |
–– |
27 (96.2%) |
| 7 |
PSADT > 10 months and PSA < 2ng/mL? |
–– |
–– |
–– |
–– |
–– |
28 (100%) |
| What is your management of M0 CRPC in the majority of men with a life expectancy < 10-15 years and with… |
a) Apalutamide or Enzalutamide |
b) Apalutamide |
c) Enzalutamide |
d) Bicalutamide or Flutamide |
e) Docetaxel |
f) I would not start any specific systemic therapy until the development of clinical metastases |
| 8 |
PSADT ≤ 10 months and PSA ≥ 2ng/mL? |
26 (92.3%) |
–– |
–– |
–– |
–– |
2 (7.7%) |
| 9 |
PSADT ≤ 10 months and PSA < 2ng/mL? |
18 (65.4%) |
1 (3.9%) |
–– |
–– |
–– |
9 (30.8%) |
| 10 |
PSADT > 10 months and PSA ≥ 2ng/mL? |
1 (3.9%) |
–– |
–– |
1 (3.9%) |
–– |
26 (92.3%) |
| 11 |
PSADT > 10 months and PSA < 2ng/mL? |
–– |
–– |
–– |
–– |
–– |
28 (100%) |
| 12 |
In a patient with M0 CRPC and pelvic lymph nodes with less than 2.0 cm in minor axis do you recommend a different approach? |
|
a) Apalutamide |
b) Enzalutamide |
c) Apalutamide or Enzalutamide |
d) Bicalutamide |
e) Docetaxel |
f) Pelvic radiotherapy |
g) Stereotactic body radiotherapy (SBRT) for oligometastatic lymph node |
h) Lymphadenectomy |
|
1 (3.9%) |
–– |
15 (54%) |
1 (3.9%) |
–– |
3 (11.5%) |
6 (19.2%) |
2 (7.7%) |
| 13 |
When you recommend an antiandrogen to treat M0 CRPC, which one do you prefer? |
|
a) Apalutamide |
b) Enzalutamide |
c) Apalutamide or Enzalutamide |
d) Bicalutamide |
e) Flutamide |
|
|
|
|
6 (19.2%) |
–– |
22 (80.8%) |
–– |
–– |
|
|
|
| 14 |
In a patient with no sign of metastatic disease based on regular exams (CT scan plus bone scan) and a positive PSMA-PET CT/MRI do you recommend a different approach? |
|
a) Yes |
b) No |
|
|
|
|
|
|
|
13 (48%) |
15 (52%) |
|
|
|
|
|
|
| 15 |
In a patient with no sign of metastatic disease based on regular exams (CT scan plus bone scan) and a positive PSMA-PET CT/MRI do you recommend? |
|
a) Apalutamide |
b) Enzalutamide |
c) Apalutamide or Enzalutamide |
d) Abiraterone |
e) Bicalutamide |
f) Docetaxel (based on volume of disease) |
g) Local therapy if oligometastatic disease (SBRT, cryo, etc.) |
h) It depends on PSA dT |
|
1 (3.9%) |
1 (3.9%) |
10 (38.5%) |
2 (7.7%) |
–– |
1 (3.9%) |
7 (23.1%) |
6 (19.2%) |
| 16 |
|
|
Physicians: The drug preference is due to? |
|
|
|
a) Toxicity profile |
b) Experience |
c) Cost |
d) Access |
|
|
|
|
|
22 (76%) |
2 (8%) |
–– |
4 (16%) |
|
|
|
|
| 17 |
|
|
When do you recommend stop treatment and start a new one? |
|
|
|
a) PSA progression only |
b) Clinical progression only |
c) Radiological progression only |
d) At least two of the three criteria (PSA, clinical and radiological) |
e) Unequivocal clinical progression only |
f) Unequivocal radiological progression only |
g) Answers d, e, and f |
h) All of the above |
|
–– |
–– |
–– |
15 (53.8%) |
–– |
1 (3.8%) |
12 (42.3%) |
–– |
|
What is your drug of choice for M0 CRPC in the majority of men with a reasonable life expectancy and… |
a) Apalutamide or Enzalutamide |
b) Apalutamide |
c) Enzalutamide |
d) Bicalutamide or Flutamide |
e) Docetaxel |
f) Abstain |
| 18 |
Diabetes? |
27 (96.2%) |
1 (3.8%) |
–– |
–– |
–– |
–– |
| 19 |
Mild hypertension? |
26 (88.5%) |
–– |
2 (7.7%) |
–– |
–– |
–– |
| 20 |
Moderate hypertension? |
24 (84%) |
4 (8.0%) |
4 (8.0%) |
–– |
–– |
–– |
| 21 |
Severe hypertension? |
20 (70.8%) |
3 (12.5%) |
5 (16.7%) |
–– |
–– |
–– |
| 22 |
Cardiovascular disease (cardiac insufficiency > grade 2)? |
19 (66.7%) |
7 (25.0%) |
2 (8.3%) |
–– |
–– |
–– |
| 23 |
Cardiovascular disease (artery coronary disease)? |
15 (51.9%) |
9 (33.3%) |
4 (14.8%) |
–– |
–– |
–– |
| 24 |
Past history of seizure and/ or drugs that increase risk of seizure? |
4 (14.8%) |
22 (77.8%) |
–– |
2 (7.4%) |
–– |
–– |
| 25 |
Mental impairment disorder? |
5 (19.2%) |
23 (80.8%) |
–– |
–– |
–– |
–– |
| 26 |
Psychiatry disorders? |
8 (28.0%) |
20 (72.0%) |
–– |
–– |
–– |
–– |
| 27 |
Renal insufficiency? |
24 (84.6%) |
3 (11.5%) |
1 (3.9%) |
–– |
–– |
–– |
| 28 |
COPD? |
28 (100.0%) |
–– |
–– |
–– |
–– |
–– |
| 29 |
Past history of falls? |
8 (29.6%) |
11 (37.0%) |
9 (33.3%) |
–– |
–– |
–– |
| 30 |
Multiple medications? |
4 (14.3%) |
3 (10.7%) |
–– |
–– |
–– |
21 (75.0%) |
| What is your level of concern with enzalutamide in the treatment of M0 CRPC regarding incidence of… |
a) Low |
b) Moderate |
c) High |
d) Abstain |
|
|
|
| 31 |
Fatigue? |
2 (7.7%) |
17 (61.5%) |
9 (30.7%) |
–– |
|
|
|
| 32 |
Fracture? |
16 (57.1%) |
7 (25.0%) |
5 (17.9%) |
–– |
|
|
|
| 33 |
Falls? |
5 (18.5%) |
18 (63.0%) |
5 (18.5%) |
–– |
|
|
|
| 34 |
Hot flashes? |
25 (82.1%) |
2 (14.3%) |
1 (3.6%) |
–– |
|
|
|
| 35 |
Nausea? |
22 (78.6%) |
6 (21.4%) |
–– |
–– |
|
|
|
| 36 |
Decreased appetite? |
23 (82.1%) |
5 (17.9%_ |
–– |
–– |
|
|
|
| 37 |
Hypertension? |
13 (42.9%) |
15 (53.6%) |
1 (3.6%) |
–– |
|
|
|
| 38 |
Cardiovascular complications? |
14 (50.0%) |
14 (50.0%) |
–– |
–– |
|
|
|
| 39 |
Mental impairment disorder? |
7 (25.0%) |
18 (64.3%) |
3 (10.7%) |
–– |
|
|
|
| 40 |
Diarrhea? |
26 (92.9%) |
2 (7.1%) |
–– |
–– |
|
|
|
| 41 |
Rash? |
26 (92.9%) |
2 (7.1%) |
–– |
–– |
|
|
|
| 42 |
Arthralgia? |
25 (89.3%) |
3 (10.7%) |
–– |
–– |
|
|
|
| 43 |
Dizziness? |
17 (60.7%) |
11 (39.3%) |
–– |
–– |
|
|
|
| 44 |
Seizure? |
14 (50.0%) |
12 (42.9%) |
2 (7.1%) |
–– |
|
|
|
| 45 |
Hepatic impairment? |
28 (100.0%) |
–– |
–– |
–– |
|
|
|
| What is your level of concern with apalutamide in the treatment of M0 CRPC regarding the incidence of… |
a) Low |
b) Moderate |
c) High |
d) Abstain |
|
|
|
| 46 |
Fatigue? |
9 (30.8%) |
16 (57.7%) |
3 (11.5%) |
–– |
|
|
|
| 47 |
Fracture? |
11 (39.3%) |
13 (46.4%) |
4 (14.3%) |
–– |
|
|
|
| 48 |
Falls? |
10 (35.7%) |
15 (53.6%) |
3 (10.7%) |
–– |
|
|
|
| 49 |
Hot flashes? |
13 (82.1%) |
4 (14.3%) |
1 (3.6%) |
–– |
|
|
|
| 50 |
Nausea? |
22 (78.6%) |
6 (21.4%) |
–– |
–– |
|
|
|
| 51 |
Decreased appetite? |
24 (85.7%) |
4 (14.3%) |
–– |
–– |
|
|
|
| 52 |
Hypertension? |
10 (37.0%) |
11 (40.7%) |
7 (22.2%) |
–– |
|
|
|
| 53 |
Cardiovascular complications? |
18 (64.3%) |
10 (35.7%) |
–– |
–– |
|
|
|
| 54 |
Mental impairment disorder? |
23 (82.1%) |
5 (17.9%) |
–– |
–– |
|
|
|
| 55 |
Diarrhea? |
23 (82.1%) |
5 (17.9%) |
–– |
–– |
|
|
|
| 56 |
Rash? |
8 (28.6%) |
15 (53.6%) |
5 (17.9%) |
–– |
|
|
|
| 57 |
Arthralgia? |
24 (85.7%) |
4 (14.3%) |
–– |
–– |
|
|
|
| 58 |
Dizziness? |
24 (85.7%) |
4 (14.3%) |
–– |
–– |
|
|
|
| 59 |
Seizure? |
25 (89.3%) |
3 (10.7%) |
–– |
–– |
|
|
|
| 60 |
Hepatic impairment? |
27 (96.4%) |
1 (3.6%) |
–– |
–– |
|
|
|
| 3. USE OF OSTEOCLAST-TARGETED THERAPY FOR SRE/SSE PREVENTION FOR ADVANCED PROSTATE CANCER (NOT FOR OSTEOPOROSIS/BONE LOSS) |
| 61 |
Which osteoclast-targeted therapy do you recommend for men with M0 CRPC for SRE/SSE prevention? |
|
a) Zoledronic acid |
b) Denosumab |
c) Either zoledronic acid or denosumab |
d) Another osteoclast- targeted therapy |
e) I do not use osteoclast- targeted therapy in this setting, but may supplement calcium and vitamin D |
|
|
|
|
1 (3.6%) |
–– |
4 (14.3%) |
–– |
23 (82.1%) |
|
|
|
| When used for men with M0 CRPC, what treatment frequency do you recommend regarding… |
a) Every 12 months |
b) Every 6 months |
c) Every 3 months |
d) Every month |
e) I do not use osteoclast- targeted therapy in this setting |
|
|
| 62 |
Zoledronic acid? |
2 (8%) |
2 (8%) |
3 (12.0%) |
–– |
21 (72.0%) |
|
|
| 63 |
Denosumab? |
–– |
5 (19.3%) |
1 (3.9%) |
1 (3.9%) |
21 (73.0%) |
|
|
| 74 |
For how long do you recommend osteoclast-targeted therapy for men with M0 CRPC for SRE/SSE prevention? |
|
a) 1 year |
b) 2 years |
c) Until first SRE/SSE |
d) Until second SRE/ SSE |
e) Indefinitely |
f) Until disease progression |
g) I do not use osteoclast targeted therapy in this setting |
|
|
–– |
2 (7.4%) |
1 (3.7%) |
1 ()3.7% |
–– |
–– |
24 (85.2%) |
|
