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practice. Respondents were also asked if they believed in index lesion theory as the basis for FT. Index lesion theory was defined “in the multifocal CaP, only the index lesion, the largest tumor focus with the highest grade, determines the prognosis.”
A link to the survey was sent through e-mail to the members of Endourological Society (ES) and the American Urological Association (AUA). Approximately 3,000 members of AUA and 2,800 members of ES received requests for the study. As both the societies have heterogeneous member Tubercidin (practicing physicians, research scientist, etc.), an unknown number of recipients qualified for the study, and therefore the response rate could not be accurately calculated. The responses were automatically and anonymously collected in a spreadsheet. The study was determined to be exempt from review by institutional review board by the Office of Human Subjects Research Protection at the National Institutes of Health.
Data management was performed using Microsoft Excel version 2016 (Seattle, Washington). Statistical analysis was performed using STATA version 14.0 (StataCorp LP, Col-lege Station, TX). Pearson chi-square and Fisher’s exact test were used to comparing proportions of categorical variables. Wilcoxon rank sum test was used to compare the distribution of continuous variables. Univariate and multivariate logistic regression models were performed to identify predictors for utilization of FT in practice. Respondent’s age, practice type, oncology fellowship training, the number of CaP patients newly diagnosed per month, and the number of years in urol-ogy practice were used in regression analysis. Odds ratio (OR) with 95% confidence interval were calculated, and sta-tistical significance was defined as P < 0.05.
3.1. Respondent characteristics
Characteristics of 425 survey respondents
No. of patients seen monthly with newly diagnosed prostate cancer
nonfellowship trained physicians (29.2% vs. 21.8, P = 0.09). Furthermore, the majority of physicians who employed FT were in clinical practice for greater than 15 years (76.7% vs. 23.3%, P = 0.005). While the most common setting for utilization of FT was in patients with unilateral intermediate risk CaP (72.8%), a minor percent-age of respondents also used FT for patients with bilateral intermediate-risk and unilateral high-risk CaP (10.6% and 21.3%, respectively; Fig. 1). Majority respondents preferred to use multiparametric MRI (mp-MRI) to identify candi-dates for FT. mp-MRI was used either with systemic trans-rectal ultrasound (TRUS) biopsy (32%) or MRI-TRUS fusion biopsy (32%).
The most common FT modality used by physicians was cryoablation (56%) followed by high-intensity focused ultrasound (HIFU) (44.6%; Fig. 1). Urinary retention and erectile dysfunction were the 2 most common postoperative complications reported by the 67% and 28% of the respond-ents (Fig. 1). Among respondents who do not utilize FT, 3 most common reasons for not using FT were the lack of belief in "index lesion theory" (63%) followed by the lack of experience (41.4%) and lack in the belief of its efficacy (41.1%; Fig. 1).
3.2. Survey responses
Participants’ responses to survey questions are presented in Table 2. Half of the respondents believed FT to be at least moderately beneficial for the treatment of localized CaP. Academic urologists were more likely to consider FT beneficial (59% vs. 44%, P = 0.034). Fellowship training or the number of years in urology practice had no relation to believing how beneficial FT was (P = 0.183 and P = 0.934, respectively).
In total, 45% of participants believed in the index lesion theory. Urologists in the academic setting were more likely to believe in the index lesion theory (53.8% vs. 38.6%, P = 0.002). There was no significant difference in the belief in index lesion theory among urologic oncology fellowship trained individuals and nonfellowship trained individuals (46% vs. 44.5%, P = 0.830). Furthermore, US-based physi-cians were less inclined to believe the index lesion theory (40.8% vs. 50.7%, P = 0.04) than the overseas physicians.