Integrating lifestyle and clinical data in prostate cancer: expert assessment of a questionnaire

World Journal of Urology (2026) 44:376 https://doi.org/10.1007/s00345-026-06494-y RESEARCH Integrating lifestyle and clinical data in prostate cancer: expert assessment of a questionnaire Catarina Leitão1 · Luís Monteiro2,3,4 · Margarida Fardilha1 · Fátima Roque5 · Maria Teresa Herdeiro1 Received: 18 November 2025 / Accepted: 17 May 2026 © The Author(s) 2026 Abstract Purpose Prostate cancer (PCa) remains a significant health burden as one of the most common cancers among men worldwide. Given the growing evidence of lifestyle’s impact on PCa progression, this study evaluates multidisciplinary experts’ feedback on a novel questionnaire assessing lifestyle factors potentially influencing PCa progression. Methods Developed through systematic literature reviews and insights from focus groups with clinical practice professionals, namely interns and specialists in urology and family medicine (FM), the questionnaire covers four domains: sociodemographic data, dietary habits, lifestyle factors, and clinical data. Results The questionnaire was evaluated by 25 professionals from the fields of public health, epidemiology, urology, and family medicine (FM), as well as by two linguists and two clinical psychologists. The questionnaire was first evaluated using a 5-point Likert scale for adequacy, accuracy, completeness, format, interest, usefulness, and confidence. Subsequently, each domain was also assessed individually for adequacy, accuracy, and completeness, using the same Likert scale, with qualitative feedback refining the questionnaire. Overall, this questionnaire received positive evaluations, with a mean score of 4.47 ± 0.72 and a median score of 4 or higher for each assessment. All domains achieved median scores of 5 for adequacy and accuracy, though completeness scored slightly lower in the lifestyle domain. Qualitative feedback highlighted the questionnaire’s relevance and clarity, while suggesting minor refinements. Conclusion These findings underscore the potential of this structured data collection protocol for exploring lifestyle-PCa associations, supporting future case-control studies, and advancing targeted prevention and intervention strategies for PCa risk management. Keywords Prostate cancer · Questionnaire development · Expert assessment · Lifestyle factors · Dietary habits · Clinical data Catarina Leitão Luís Monteiro Margarida Fardilha Fátima Roque Maria Teresa Herdeiro 1 Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Campus Universitário de Santiago, Aveiro 3810-193, Portugal 2 CINTESIS – Centre for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal 3 Department of Medical Sciences, University of Aveiro, Campus Universitário de Santiago, Aveiro 3810-193, Portugal 4 USF Esgueira +, ULS Região Aveiro, Aveiro 3800-322, Portugal 5 BRIDGES - Biotechnology Research, Innovation and Design for Health Products, Polytechnic University of Guarda, Avenida Dr. Francisco Sá Carneiro, n. 50, Guarda 6300- 559, Portugal 376 Page 2 of 9 Introduction Prostate cancer (PCa) is the fourth most frequently diagnosed malignancy and the eight leading cause of cancerrelated mortality worldwide, with over one million cases reported in 2022 [1]. Its global burden is particularly significant in Europe and Asia, accounting for over 30% of diagnoses and deaths, respectively [1, 2]. While established risk factors such as age, race, family history, and genetic predisposition are non-modifiable, emerging evidence highlights the growing impact of modifiable lifestyle factors on PCa development and progression. Dietary habits, physical activity, alcohol consumption, and smoking are increasingly recognized as contributors to chronic inflammation [3, 4] and oxidative stress, mechanisms implicated in cancer development [3, 5]. Despite the growing interest in lifestyle and cancer prevention, studies investigating the impact of lifestyle on PCa risk have yielded inconsistent results [3, 6, 7], partly due to methodological heterogeneity and limitations in data collection instruments. There are numerous questionnaires commonly used with patients with PCa that serve as fundamental tools for assessing various aspects related to the disease. Although these studies do not provide specific examples of standardized questionnaires, such as the International Prostate Symptom Score (IPSS) or the Expanded Prostate Cancer Index Composite (EPIC), they still offer valuable information regarding the main domains typically assessed by these instruments. Many existing tools, however, are limited in scope, focusing primarily on symptoms, treatment side effects, and quality of life (QoL), as exemplified by the questionnaires mentioned above. Additionally, few instruments are specifically tailored to the unique context of PCa. For instance, the IPSS is widely used but primarily designed for patients with benign prostatic hyperplasia (BPH) [8, 9], as it focuses mainly on urinary symptoms. In contrast, the EPIC, developed for PCa patients, comprises 50 questions covering five clinical domains: urinary incontinence, obstructive urinary symptoms, intestinal symptoms, sexual symptoms, and hormonal symptoms, each scored separately [10, 11]. Additionally, there are questionnaires and risk calculators specifically designed to evaluate PCa risk factors. These tools incorporate a range of variables including age, family history, ethnicity, urinary symptoms and results of clinical tests such as prostate-specific antigen (PSA) levels and digital rectal examination (DRE) findings [12, 13]. However, regarding modifiable risk factors, existing tools are limited in scope, often assessing only individual lifestyle domains (e.g., diet or physical activity) [14–16]. To address this gap, we developed a questionnaire covering four key domains: sociodemographic data, dietary habits, lifestyle, and clinical factors (see Online Resource 13 World Journal of Urology (2026) 44:376 1). The primary aim of this study is to evaluate the feedback from health professionals, linguists, and clinical psychologists obtained during an expert-based face and content validation of the questionnaire. This evaluation seeks to identify areas for improvement, ensuring the tool’s clarity, relevance, and alignment with current knowledge on PCa risk factors. Ultimately, this assessment may support future research, by providing a comprehensive tool that may help streamline data collection regarding modifiable risk factors and contribute to preventive and intervention strategies. Materials and methods Ethical considerations This study consisted of an online expert review of a research questionnaire, by appraising the wording, structure, and content of each item and by providing methodological feedback (e.g., adequacy, accuracy, completeness, usefulness, and format). Experts were not asked to complete the questionnaire as respondents. Therefore, (...truncated)