Insights on Early Prostate Cancer (PCa) Epidemiology and Treatment Pathways From an Online Modified Delphi Panel

OBJECTIVES: Limited literature on early PCa epidemiology and treatment pathways underscores a need for deeper understanding of these characteristics in real-world settings. To address this, we conducted an online modified Delphi panel.

METHODS: We utilised a pre-specified Delphi protocol and anonymous online market research panel to seek consensus on key areas of early PCa epidemiology and treatment. Panellists were urologists and radio-oncologists from France, Germany, Spain, Italy, and Belgium. Three rounds were planned; two were completed (Round 1, N=113; Round 2, N=72), followed by qualitative interviews of respondents (n=10) to investigate the results. Questions were generated with an expert Steering Committee, geared to seek consensus or identify numerical estimates to seek consensus in Round 3.

RESULTS: Consensus was reached for some questions, including risk stratification systems and assessments to diagnose and stage PCa. However, some results showed variability between respondents across both Delphi rounds; e.g. in Round 2, variation was observed in the reported proportion of metastatic PCa cases at diagnosis (mean 37.2%±16.7 [SD]), with mean responses varying between countries (29.1–44.0%), specialties (urologists: 33.0%; radio-oncologists: 44.1%) and hospital-settings (21.4−39.3% in primary- to tertiary-level, respectively). These responses differed from published estimates (5%).¹ Treatment patterns also showed variability; e.g. in Round 2, the reported proportion of patients receiving salvage therapy following local/regional recurrence after primary radiotherapy varied (51.8%±26.5), with deviation across specialty (urologists: 49.2%; radio-oncologists: 55.9%) and country (41.5–64.4%). Interviews indicated that setting, case mix, screening practices, evolving clinical practice and question interpretation contributed.

CONCLUSIONS: This online modified Delphi panel reached consensus on some aspects of PCa, though conclusions on other features of early PCa epidemiology and treatment pathways were not attained due to variability in results. Whilst some variation is likely to be genuine and driven by local specificities, limitations with this online methodology may have contributed.