PART II of the Questionnaire
CLINICAL SCENARIO N°1: Low risk- 65y
65years old man, without any comorbidity.
Screening PSA: 4,5 ng/mL.
Normal digital rectal exam.
No LUTS.
No knownprevious PSA value
US prostate volume: 40mL
Core biopsies: 2/12 positive core biopsies. Gleason score: 6(3+3).
TumoralLength: 2mm/10mm and 3mm/13mm.
Question n°1/ What extension work-up would you do? (Multiple-choice question)
None
Abdominal CT scan
Prostatic MRI
Bone scan
Question n°2/ Which treatment options would you consider in this setting?(Multiple-choice question)
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy
Brachytherapy
Palliative intent treatment:
Hormonal treatment
Question n°3/What treatment options would you suggest to the patient? (one answer).
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy
Brachytherapy
Palliative intent treatment:
Hormonal treatment
CLINICAL SCENARIO n°2: Low risk- 75y
75years old man, without any comorbidity.
Screening PSA: 4,5 ng/mL.
Normal digital rectal exam.
No LUTS.
No knownprevious PSA value.
US prostate volume: 40mL.
Core biopsies: 2/12 positive core biopsies. Gleason score: 6(3+3).
TumoralLength: 2mm/10mm and 3mm/13mm.
Question n°1/ What extension work-up would you do? (Multiple choice question)
None
Abdominal CT scan
Prostatic MRI
Bone scan
Question n°2/ Which treatment options would you consider in this setting?(Multiple-choice question)
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy
Brachytherapy
Palliative intent treatment:
Hormonal treatment
Question n°3/ What treatment options would you suggest to the patient? (one answer).
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy
Brachytherapy
Palliative intent treatment:
Immediate hormonal treatment
Hormonal treatment for rising PSA
CLINICAL SCENARIO N°3: middle risk- 65y
65years old man, without any comorbidity.
Screening PSA: 8,5 ng/mL.
Normal digital rectal exam.
No LUTS.
No known previous PSA value.
US prostate volume: 40mL
Core biopsies: 2/12 positive core biopsies. Gleason score: 7(3+4).
TumoralLength: 2mm/10mm and 3mm/13mm.
MRI: no extra capsular spread, VS normal, no lymphadenopathy
Question n°1/ What extension work-up would you do? (Multiple-choice question)
None
Abdominal CT scan
Bone scan
Question n°2/ Which treatment options would you consider in this setting?(Multiple-choice question)
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy with or without adjuvant hormonal treatment
Brachytherapy
Palliative intent treatment:
Immediate hormonal treatment
Hormonal treatment for rising PSA
Question n°3/ What treatment options would you suggest to the patient? (one answer).
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy with or without adjuvant hormonal treatment
Brachytherapy
Palliative intent treatment:
Immediate hormonal treatment
Hormonal treatment for rising PSA
CLINICAL SCENARIO n°4: middle risk- 75y
75years old man, without any comorbidity.
Screening PSA: 8,5 ng/mL.
Normal digital rectal exam.
No LUTS.
No known previous PSA value.
US prostate volume: 40mL.
Core biopsies: 2/12 positive core biopsies. Gleason score: 7(3+4).
TumoralLength: 2mm/10mm and 3mm/13mm.
MRI: no extracapsular spread, VS normal, no lymphadenopathy.
Question n°1/ What extension work-up would you do? (Multiple-choice question)
None
Abdominal CT scan
Bone scan
Question n°2/ Which treatment options would you consider in this setting?(Multiple-choice question)
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy with or without adjuvant hormonal treatment
Brachytherapy
Palliative intent treatment:
Immediate hormonal treatment
Hormonal treatment for rising PSA
Question n°3/ What treatment options would you suggest to the patient? (one answer).
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy with or without adjuvant hormonal treatment
Brachytherapy
Palliative intent treatment:
Immediate hormonal treatment
Hormonal treatment for rising PSA
CLINICAL SCENARIO n°5: Middle risk-81y
81years old man, without any comorbidity.
Screening PSA: 8,5 ng/mL.
Normal digital rectal exam.
No LUTS.
No known previous PSA value.
US prostate volume: 40mL.
Core biopsies: 2/12 positive core biopsies. Gleason score: 7(3+4).
TumoralLength: 2mm/10mm and 3mm/13mm.
MRI: no extracapsular spread, VS normal, no lymphadenopathy.
Question n°1/ What extension work-up would you do? (Multiple-choice question)
None
Abdominal CT scan
Bone scan
Question n°2/ Which treatment options would you consider in this setting?(Multiple-choice question)
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy with or without adjuvant hormonal treatment
Brachytherapy
Palliative intent treatment:
Immediate hormonal treatment
Hormonal treatment for rising PSA
Question n°3/ What treatment options would you suggest to the patient? (one answer).
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy with or without adjuvant hormonal treatment
Brachytherapy
Palliative intent treatment:
Immediate hormonal treatment
Hormonal treatment for rising PSA
CLINICAL SCENARIO N°6: High risk- 65ans
65years old man, without any comorbidity.
Screening PSA: 13 ng/mL.
Digital rectal exam: hard lump in the right lobe. Extra capsular spread:medial + apex
No LUTS.
No known previous PSA value.
US prostate volume: 40mL
Core biopsies: 4/12 positive core biopsies. Gleason score: 7(4+3).
TumoralLength:45mm/112mm.
MRI:Both lobes involved. Extracapsular spread. Seminal vesicle and lymph nodes not involved. No lymphadenopathy
Bone scan: normal
Question n°1/ Which treatment options would you consider in this setting?(Multiple-choice question)
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy with or without adjuvant hormonal treatment
Brachytherapy
Palliative intent treatment:
Immediate hormonal treatment
Hormonal treatment for rising PSA
Question n°2/ What treatment options would you suggest to the patient? (one answer).
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy with or without adjuvant hormonal treatment
Brachytherapy
Palliative intent treatment:
Immediate hormonal treatment
Hormonal treatment for rising PSA
CLINICAL SCENARIO N°7: High risk- 75ans
75years old man, without any comorbidity.
Screening PSA: 13 ng/mL.
Digital rectal exam: hard lump in the right lobe. Extra capsular spread:medial + apex
No LUTS.
No known previous PSA value.
US prostate volume: 40mL
Core biopsies: 4/12 positive core biopsies. Gleason score: 7(4+3).
TumoralLength: 45mm/112mm.
MRI: Both lobes involved. Extracapsular spread. Seminal vesicle and lymph nodes not involved.
Bone scan: normal
Question n°1/ Which treatment options would you consider in this setting?(Multiple-choice question)
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy with or without adjuvant hormonal treatment
Brachytherapy
Palliative intent treatment:
Immediate hormonal treatment
Hormonal treatment for rising PSA
Question n°2/ What treatment options would you suggest to the patient? (one answer).
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy with or without adjuvant hormonal treatment
Brachytherapy
Palliative intent treatment:
Immediate hormonal treatment
Hormonal treatment for rising PSA
CLINICAL SCENARIO N° 8:
65years old man, without any comorbidity.
Screening PSA: 17ng/mL.
Digital rectal exam: hard lump in the right lobe. Extra capsular spread:medial + apex
No LUTS.
No known previous PSA value.
US prostate volume: 40mL
Core biopsies: 4/12 positive core biopsies. Gleason score: 7(4+3).
TumoralLength: 85mm/120mm.
MRI: Both lobes involved. Extracapsular spread, staging by radiologist iT3a. Seminal vesicle and lymph nodes not involved.
Bone scan: normal
Question n°1/ Which treatment options would you consider in this setting?(Multiple-choice question)
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy with or without adjuvant hormonal treatment
Brachytherapy
Palliative intent treatment:
Immediate hormonal treatment
Hormonal treatment for rising PSA
Question n°2/ What treatment options would you suggest to the patient? (one answer).
Curative intent treatment:
Active surveillance
Radical prostatectomy
External beam radiotherapy with or without adjuvant hormonal treatment
Brachytherapy
Palliative intent treatment:
Immediate hormonal treatment.
Hormonal treatment for rising PSA
CLINICAL SCENARIO N°9:
65years old man, without any comorbidity.
Screening PSA: 8 ng/mL.
Normal digital rectal exam.
No LUTS.
No known previous PSA value.
Core biopsies: 4/12 positive core biopsies. Gleason score: 7(4+3).
Bone scan: normal.
A radical prostatectomy is performed.
Pathological examination: pT3a R0 pN0 M0 Gleason 7(4+3). 6 lymph nodes were found.
Postoperative PSA (Month two) is undetectable.
Question n°1/ Which treatment options would you consider in this setting?(Multiple-choice question)
Monitoring
External beam radiotherapy with or without adjuvant hormonal treatment
Radiotherapy if rising PSA
Immediate Hormonal therapy
Hormonal treatment if rising PSA
Hormonal treatment if clinical recurrence
Question n°2/ What treatment options would you suggest to the patient? (one answer).
Monitoring
External beam radiotherapy with or without adjuvant hormonal treatment
Radiotherapy if rising PSA
Immediate Hormonal therapy
Hormonal treatment if rising PSA
Hormonal treatment if clinical recurrence
CLINICAL SCENARIO N° 10:
65years old man, without any comorbidity.
Screening PSA: 8 ng/mL.
Normal digital retalexam.
No LUTS.
No known previous PSA value.
Core biopsies: 4/12 positive core biopsies. Gleason score: 7(4+3).
Bone scan: normal.
A radical prostatectomy is performed.
Pathological examination: pT3a R1 pN0 M0 Gleason 7(4+3). 6 lymph nodes were found.
Postoperative PSA (Month two) is undetectable.
Question n°1/ Which treatment options would you consider in this setting?(Multiple-choice question)
Monitoring
External beam radiotherapy with or without adjuvant hormonal treatment
Radiotherapy if rising PSA
Immediate Hormonal therapy
Hormonal treatment if rising PSA
Hormonal treatment if clinical recurrence
Question n°2/ What treatment options would you suggest to the patient? (one answer).
Monitoring
External beam radiotherapy with or without adjuvant hormonal treatment
Radiotherapy if rising PSA
Immediate Hormonal therapy
Hormonal treatment if rising PSA
Hormonal treatment if clinical recurrence
CLINICAL SCENARIO N° 11:
65years old man, without any comorbidity.
Screening PSA: 8 ng/mL.
Normal digital rectal exam.
No LUTS.
No known previous PSA value.
Core biopsies: 4/12 positive core biopsies. Gleason score: 7(4+3).
Bone scan: normal.
A radical prostatectomy is performed.
Pathological examination: pT3a R1 pN0 M0 Gleason 7(4+3). 6 lymph nodes were found.
Postoperative PSA (Month two) is undetectable.
At the follow-up, PSA level is 0,15 ng/mL at month 8 and 0,3ng/mL at month 18.
Question n°1/ Which treatment options would you consider in this setting?(Multiple-choice question)
Monitoring
External beam radiotherapy with or without adjuvant hormonal treatment
Immediate Hormonal therapy
Hormonal treatment if clinical recurrence
Question n°2/ What treatment options would you suggest to the patient? (one answer).
Monitoring
External beam radiotherapy with or without adjuvant hormonal treatment
Immediate Hormonal therapy
Hormonal treatment if clinical recurrence