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Duwe G, Boehm K, Becker G, Ruckes C, Sparwasser P, Haack M, Dotzauer R, Thomas A, Mager R, Tsaur I, Neumann CCM, Feick G, Carl G, Brandt MP, Haferkamp A, Höfner T. Individualized center-based analysis of urinary and sexual functional outcome after radical prostatectomy based on the prostate cancer outcome study: a post hoc pathway to patient outcome measurement analysis for quality improvement. World J Urol 2024; 42:236. [PMID: 38619659 DOI: 10.1007/s00345-024-04950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/08/2024] [Indexed: 04/16/2024] Open
Abstract
PURPOSE We evaluate differences of patient-reported outcome measurements (PROM) based urinary continence and sexual function 12 months after radical prostatectomy (RPE) based on perioperative, surgical, and patient-specific characteristics in a large European academic urology center. MATERIALS AND METHODS All men enrolled in the Prostate Cancer Outcome Study (PCO) study who were treated with RPE between 2017 and 2021 completed EPIC-26 information surveys before and 12 months after RPE. Survey data were linked to clinical data of our institution. Logistic regression analyses were performed to examine the correlation between individual surgeons, patient characteristics, patient clinical data, and their urinary continence and sexual function. RESULTS In total, data of 429 men were analyzed: unstratified mean (SD) EPIC-26 domain score for urinary function decreased from 93.3 (0.7) to 60.4 (1.5) one year after RPE, respectively for sexual function from 64.95 (1.6) to 23.24 (1.1). Patients with preoperative adequate urinary function (EPIC-26 score > 80) reported significantly different mean urinary function scores between 53.35 (28.88) and 66.25 (25.15), p= 0.001, stratified by surgeons experience. On binary logistic regression analyses, only nerve sparing techniques (OR: 1,83, 95% CI: 1.01;3.21; p = 0.045) and low body mass index (OR: 0.91, CI: 0.85;0.99, p= 0.032) predicted adequate postoperative urinary function. CONCLUSIONS The results show how using provider-specific data from a larger cohort study enables to develop institution-specific analysis for functional outcomes after RPE. These models can be used for internal quality improvement as well as enhanced and provider-specific patient communication and shared decision making.
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Affiliation(s)
- Gregor Duwe
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Katharina Boehm
- Department of Urology, University Hospital Carl Gustav-Carus, TU Dresden, 01307, Dresden, Germany
| | - Gerrit Becker
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials Mainz, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Peter Sparwasser
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Maximilian Haack
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Robert Dotzauer
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Anita Thomas
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Christopher C M Neumann
- Department of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10117, Berlin, Germany
| | - Günther Feick
- Federal Association of German Prostate Cancer Patient Support Groups, Thomas-Mann Strasse 40, 55311, Bonn, Germany
| | - Günter Carl
- Federal Association of German Prostate Cancer Patient Support Groups, Thomas-Mann Strasse 40, 55311, Bonn, Germany
| | - Maximilian Peter Brandt
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Thomas Höfner
- Department of Urology and Pediatric Urology, University Medical Center Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
- Department of Urology, Ordensklinikum Linz Elisabethinen, Fadingerstrasse 1, 4020, Linz, Austria
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Sibert NT, Kurth T, Breidenbach C, Wesselmann S, Feick G, Carl EG, Dieng S, Albarghouth MH, Aziz A, Baltes S, Bartolf E, Bedke J, Blana A, Brock M, Conrad S, Darr C, Distler F, Drosos K, Duwe G, Gaber A, Giessing M, Harke NN, Heidenreich A, Hijazi S, Hinkel A, Kaftan BT, Kheiderov S, Knoll T, Lümmen G, Peters I, Polat B, Schrodi V, Stolzenburg JU, Varga Z, von Süßkind-Schwendi J, Zugor V, Kowalski C. Prediction models of incontinence and sexual function one year after radical prostatectomy based on data from 20 164 prostate cancer patients. PLoS One 2023; 18:e0295179. [PMID: 38039308 PMCID: PMC10691723 DOI: 10.1371/journal.pone.0295179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Incontinence and sexual dysfunction are long-lasting side effects after surgical treatment (radical prostatectomy, RP) of prostate cancer (PC). For an informed treatment decision, physicians and patients should discuss expected impairments. Therefore, this paper firstly aims to develop and validate prognostic models that predict incontinence and sexual function of PC patients one year after RP and secondly to provide an online decision making tool. METHODS Observational cohorts of PC patients treated between July 2016 and March 2021 in Germany were used. Models to predict functional outcomes one year after RP measured by the EPIC-26 questionnaire were developed using lasso regression, 80-20 splitting of the data set and 10-fold cross validation. To assess performance, R2, RMSE, analysis of residuals and calibration-in-the-large were applied. Final models were externally temporally validated. Additionally, percentages of functional impairment (pad use for incontinence and firmness of erection for sexual score) per score decile were calculated to be used together with the prediction models. RESULTS For model development and internal as well as external validation, samples of 11 355 and 8 809 patients were analysed. Results from the internal validation (incontinence: R2 = 0.12, RMSE = 25.40, sexual function: R2 = 0.23, RMSE = 21.44) were comparable with those of the external validation. Residual analysis and calibration-in-the-large showed good results. The prediction tool is freely accessible: https://nora-tabea.shinyapps.io/EPIC-26-Prediction/. CONCLUSION The final models showed appropriate predictive properties and can be used together with the calculated risks for specific functional impairments. Main strengths are the large study sample (> 20 000) and the inclusion of an external validation. The models incorporate meaningful and clinically available predictors ensuring an easy implementation. All predictions are displayed together with risks of frequent impairments such as pad use or erectile dysfunction such that the developed online tool provides a detailed and informative overview for clinicians as well as patients.
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Affiliation(s)
| | - Tobias Kurth
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Günther Feick
- Bundesverband Prostatakrebs Selbsthilfe, Bonn, Germany
| | | | | | | | | | - Stefan Baltes
- KRH Klinikum Region Hannover, Klinikum Siloah—Oststadt—Heidehaus, Hannover, Germany
| | | | - Jens Bedke
- University Hospital Tübingen, Tübingen, Germany
| | | | - Marko Brock
- Ruhr-University Bochum, Marien Hospital, Herne, Germany
| | | | | | | | | | | | - Amr Gaber
- Carl-Thiem-Klinikum, Cottbus, Germany
| | | | | | | | | | | | | | | | - Thomas Knoll
- Klinikum Sindelfingen-Böblingen, Sindelfingen, Germany
| | | | - Inga Peters
- Krankenhaus Nordwest, Frankfurt am Main, Germany
| | | | | | | | - Zoltan Varga
- SRH Kliniken Landkreis Sigmaringen, Sigmaringen, Germany
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Sibert NT, Pfaff H, Breidenbach C, Wesselmann S, Roth R, Feick G, Carl G, Dieng S, Gaber AA, Blana A, Darr C, Distler F, Kunath F, Bedke J, Erdmann J, Minner J, Simon J, Kwiatkowski M, Burchardt M, Harz N, Conrad S, Höfner T, Knoll T, Beyer B, Hammerer P, Kowalski C. Variation across operating sites in urinary and sexual outcomes after radical prostatectomy in localized and locally advanced prostate cancer. World J Urol 2022; 40:1437-1446. [PMID: 35347412 DOI: 10.1007/s00345-022-03985-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The extent of variation in urinary and sexual functional outcomes after radical prostatectomy (RPE) between prostate cancer (PC) operating sites remains unknown. Therefore, this analysis aims to compare casemix-adjusted functional outcomes (EPIC-26 scores incontinence, irritative/obstructive function and sexual function) between operating sites 12 months after RPE. MATERIALS AND METHODS Analysis of a cohort of 7065 men treated with RPE at 88 operating sites (prostate cancer centers, "PCCs") between 2016 and 2019. Patients completed EPIC-26 and sociodemographic information surveys at baseline and 12 months after RPE. Survey data were linked to clinical data. EPIC-26 domain scores at 12 months after RPE were adjusted for relevant confounders (including baseline domain score, clinical and sociodemographic information) using regression analysis. Differences between sites were described using minimal important differences (MIDs) and interquartile ranges (IQR). The effects of casemix adjustment on the score results were described using Cohen's d and MIDs. RESULTS Adjusted domain scores at 12 months varied between sites, with IQRs of 66-78 (incontinence), 89-92 (irritative/obstructive function), and 20-29 (sexual function). Changes in domain scores after casemix adjustment for sites ≥ 1 MID were noted for the incontinence domain (six sites). Cohen's d ranged between - 0.07 (incontinence) and - 0.2 (sexual function), indicating a small to medium effect of casemix adjustment. CONCLUSIONS Variation between sites was greatest in the incontinence and sexual function domains for RPE patients. Future research will need to identify the factors contributing to this variation. TRIAL REGISTRY The study is registered at the German Clinical Trial Registry ( https://www.drks.de/drks_web/ ) with the following ID: DRKS00010774.
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Affiliation(s)
- Nora Tabea Sibert
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany.
| | - Holger Pfaff
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Clara Breidenbach
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany
| | - Simone Wesselmann
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany
| | - Rebecca Roth
- Faculty of Medicine and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, University of Cologne, Robert-Koch-Str. 10, 50931, Cologne, Germany
| | - Günther Feick
- Federal Association of German Prostate Cancer Patient Support Groups, Bonn, Germany
| | - Günter Carl
- Federal Association of German Prostate Cancer Patient Support Groups, Bonn, Germany
| | | | - Amr A Gaber
- Urologische Klinik, Carl-Thiem-Klinikum Cottbus, Thiemstr. 111, 03048, Cottbus, Germany
| | - Andreas Blana
- Klinik für Urologie und Kinderurologie, Klinikum Fürth, Jakob-Henle-Strasse 1, 90766, Fürth, Germany
| | - Christopher Darr
- Klinik für Urologie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Florian Distler
- Klinik für Urologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Standort Klinikum Nürnberg, Prof.-Ernst-Nathan-Straße 1 (Haus 22), 90419, Nuremberg, Germany
| | - Frank Kunath
- Department of Urology and Pediatric Urology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Jens Bedke
- Klinik für Urologie, Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Jörg Erdmann
- Prostatakarzinomzentrum Tauber-Franken, Uhlandstr. 7, 97980, Bad Mergentheim, Germany
| | - Jörg Minner
- Hegau-Bodensee-Klinikum GmbH, Virchowstraße 10, 78224, Singen, Germany
| | - Jörg Simon
- Klinik für Urologie und Kinderurologie, Ortenau Klinikum, Ebertplatz 12, 77654, Offenburg, Germany
| | - Maciej Kwiatkowski
- Kantonsspital Aarau AG, Onkologiezentrum Mittelland, Tellstrasse 25, 5001, Aarau, Switzerland
| | - Martin Burchardt
- Klinik und Poliklinik für Urologie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Nino Harz
- Klinikum Dortmund, Münsterstraße 240, 44145, Dortmund, Germany
| | - Stefan Conrad
- DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Germany
| | - Thomas Höfner
- Klinik und Poliklinik für Urologie und Kinderurologie, UNIVERSITÄTSMEDIZIN der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Thomas Knoll
- Kliniken Sindelfingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Germany
| | - Burkhard Beyer
- Martini-Klinik Prostate Cancer Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Peter Hammerer
- Städtisches Klinikum Braunschweig, Freisestraße 9/10, 38118, Braunschweig, Germany
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Kowalski C, Sibert N, Breidenbach C, Feick G, Carl G, Roth R, Dieng S, Wesselmann S, Burchardt M, Fichtner J. Comparing quality of care using patient-reported outcomes in patients with localized prostate cancer. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The Prostate Cancer Outcomes (PCO) study, funded by the Movember Foundation, has been recruiting patients in prostate cancer centers in Germany, Austria and Switzerland certified by the German Cancer Society (DKG) since July 2016. It is a joint project of the Federal Prostate Cancer Self-Help Association (BPS), DKG, OnkoZert and meanwhile over 100 participating centers. The aim of the study is to compare the outcome quality between the centers for mutual learning and to use patient-specific evaluations for treatment planning.
Materials and Methods
The protocol was set up according to the International Consortium for Health Outcomes Measurement (ICHOM) Standard Data Set with patients filling out the EPIC-26 before and at least once (after 12 months) after treatment. The EPIC-26 includes the functional outcome domains 'incontinence', 'irritative / obstructive', 'gastrointestinal', 'sexuality', and 'hormonal “. Questionnaire data are linked to disease and treatment data in the centers. The EPIC-26 domain scores are then analyzed centrally to provide case mix adjusted center comparisons stratified by treatment.
Results
As of May 2019, 11,303 patients were recruited the PCO study. For 3,953 of them, results of the follow-up survey after 12 months were available for analysis. The results show changes in the scores similar (e.g. an adjusted decrease in the incontinence domain by 15 points for patients receiving radical prostatectomy) to what was known from the international literature 12 months after primary therapy. Results vary significantly between the centers, suggesting differences between providers that warrant improvement interventions.
Conclusions
The results are used to develop strategies for improvement together with providers and patients and to implement patient-specific evaluations for treatment planning in everyday treatment.
Key messages
A patient-reported outcome routine was successfully implemented in over 100 prostate cancer units in central Europe adopting the same data infrastructure. Benchmarking results demonstrate meaningfully differences across units that warrant improvement interventions.
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Affiliation(s)
- C Kowalski
- German Cancer Society, Berlin, Germany
- German Society of Medical Sociology, Hamburg, Germany
| | - N Sibert
- German Cancer Society, Berlin, Germany
| | | | - G Feick
- Federal Prostate Cancer Self Help Association, Bonn, Germany
| | - G Carl
- Federal Prostate Cancer Self Help Association, Bonn, Germany
| | - R Roth
- University of Cologne, Cologne, Germany
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Kowalski C, Lüll A, Feick G, Carl G, Wesselmann S, Dieng S. Die PCO-Studie zur Erfassung von PROs in der Routineversorgung von Prostatakrebspatienten – Erste Ergebnisse aus zertifizierten Zentren in Deutschland und der Schweiz. Psychother Psych Med 2018. [DOI: 10.1055/s-0038-1667979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- C Kowalski
- Deutsche Krebsgesellschaft e.V., Bereich Zertifizierung, Berlin, Deutschland
| | | | - G Feick
- Bundesverband Prostatakrebs Selbsthilfe e.V., Haus der Krebs-Selbsthilfe, Bonn, Deutschland
| | | | - S Wesselmann
- Deutsche Krebsgesellschaft e.V., Berlin, Deutschland
| | - S Dieng
- Onkozert GmbH, Datenmanagement, Neu-Ulm, Deutschland
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Valdagni R, Van Poppel H, Aitchison M, Albers P, Berthold D, Bossi A, Brausi M, Denis L, Drudge-Coates L, Feick G, Hoyer M, Hummel H, Mirone V, Müller S, Parker C, Sternberg C, Tombal B, van Muilekom E, Watson M, Wesselmann S, Costa A. Prostate cancer unit initiative in europe: a consensus on standards of care. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv341.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Valdagni R, Van Poppel H, Aitchison M, Albers P, Berthold D, Bossi A, Brausi M, Denis L, Drudge-Coates L, De Santis M, Feick G, Harrison C, Haustermans K, Hollywood D, Hoyer M, Hummel H, Mason M, Mirone V, Müller SC, Parker C, Saghatchian M, Sternberg CN, Tombal B, van Muilekom E, Watson M, Wesselmann S, Wiegel T, Magnani T, Costa A. Prostate Cancer Unit Initiative in Europe: A position paper by the European School of Oncology. Crit Rev Oncol Hematol 2015; 95:133-43. [PMID: 26092320 DOI: 10.1016/j.critrevonc.2015.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/04/2015] [Accepted: 05/26/2015] [Indexed: 02/06/2023] Open
Abstract
The Prostate Cancer Programme of the European School of Oncology developed the concept of specialised interdisciplinary and multiprofessional prostate cancer care to be formalized in Prostate Cancer Units (PCU). After the publication in 2011 of the collaborative article "The Requirements of a Specialist Prostate Cancer Unit: A Discussion Paper from the European School of Oncology", in 2012 the PCU Initiative in Europe was launched. A multiprofessional Task Force of internationally recognized opinion leaders, among whom representatives of scientific societies, and patient advocates gathered to set standards for quality comprehensive prostate cancer care and designate care pathways in PCUs. The result was a consensus on 40 mandatory and recommended standards and items, covering several macro-areas, from general requirements to personnel to organization and case management. This position paper describes the relevant, feasible and applicable core criteria for defining PCUs in most European countries delivered by PCU Initiative in Europe Task Force.
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Affiliation(s)
- Riccardo Valdagni
- European School of Oncology, Milan, Italy; Prostate Cancer Programme, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Hendrik Van Poppel
- Dept of Urology, University Hospital of the Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Peter Albers
- Dept of Urology, Heinrich Heine University Hospital, Düsseldorf, Germany
| | - Dominik Berthold
- Centre Polidisciplinaire d'Oncologie, Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Alberto Bossi
- Dept of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Maurizio Brausi
- Dept of Urology, Ausl Modena, Nuovo Ospedale Civile-S. Agostino Estense, Modena, Italy
| | - Louis Denis
- Europa Uomo, Antwerp, Belgium; Oncological Centre, Antwerp, Belgium
| | | | - Maria De Santis
- University of Warwick, Cancer Research Unit, Coventry, UK; Queen Elizabeth Hospital-Cancer Centre, Birmingham, UK
| | - Günther Feick
- Europa Uomo, Antwerp, Belgium; Bundesverband Prostatakrebs Selbsthilfe, Bonn, Germany
| | - Chris Harrison
- Greater Manchester Strategic Health Authority, Manchester, UK
| | - Karin Haustermans
- Dept. of Radiation Oncology, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Donal Hollywood
- Urologic and Radiation Oncology, Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - Morton Hoyer
- Dept of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Henk Hummel
- Integraal Kankercentrum Nederland (IKNL), Comprehensive Cancer Centre Netherlands, Utrecht, The Netherlands
| | - Malcolm Mason
- Dept of Oncology and Palliative Medicine, Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - Vincenzo Mirone
- Dept of Urology, University of Naples Federico II, Naples, Italy
| | | | - Chris Parker
- Academic Urology Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Cora N Sternberg
- Dept of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy
| | - Bertrand Tombal
- Dept of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Erik van Muilekom
- Dept of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maggie Watson
- Research Department of Clinical, Educational and Health Psychology, University College, London, UK
| | | | - Thomas Wiegel
- Dept of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Tiziana Magnani
- Prostate Cancer Programme, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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