Supplementary Material for: Therapies Used in Prostate Cancer Patients by European Urologists: Data on Indication with a Focus on Expectations, Perceived Barriers and Guideline Compliance Related to the Use of Bisphosphonates

<b><i>Introduction:</i></b> The aim of our survey was to evaluate the usage and indications of various metastatic prostate cancer (PCa) therapies, and to identify barriers to usage of bisphosphonates (BPs). <b><i>Materials and Methods:</i></b> Between March and June 2009, an internet-based survey was performed among board-certified urologists of the EAU who treated ≥10 patients with metastatic PCa annually. <b><i>Results:</i></b> Questionnaires completed by 200 urologists from 12 European countries including 27,442 PCa patients were used for analyses. On average, 22% of the patients presented in stage IV, 15% had bone metastases and 10% received BPs. In most countries, BPs were used to the same extent in hormone-naïve and castration-resistant PCa (CRPC). A total of 23% of urologists prescribed chemotherapy in patients with hormone-sensitive PCa, and 55% of the urologists did not administer androgen deprivation maintenance therapy in patients with CRPC. <b><i>Conclusions:</i></b> BPs were frequently used in PCa with bone metastases, although current guidelines recommend their use only in CRPC. Standardized multidisciplinary educational programs should be developed in order to prevent non-indicated early chemotherapy in hormone-sensitive patients and to stimulate maintenance of androgen deprivation therapy in CRPC patients. Also, programs facilitating home infusions for patients who need intravenous BPs are needed in specific countries to optimize treatment of CRPC.