Management of Patients with Advanced Prostate Cancer. Part I: Intermediate-/High-risk and Locally Advanced Disease, Biochemical Relapse, and Side Effects of Hormonal Treatment: Report of the Advanced Prostate Cancer Consensus Conference 2022

TY - JOUR

T1 - Management of Patients with Advanced Prostate Cancer. Part I: Intermediate-/High-risk and Locally Advanced Disease, Biochemical Relapse, and Side Effects of Hormonal Treatment: Report of the Advanced Prostate Cancer Consensus Conference 2022

AU - Gillessen, Silke

AU - Bossi, Alberto

AU - Davis, Ian D

AU - de Bono, Johann

AU - Fizazi, Karim

AU - James, Nicholas D

AU - Mottet, Nicolas

AU - Shore, Neal

AU - Small, Eric

AU - Smith, Mathew

AU - Sweeney, Christopher

AU - Tombal, Bertrand

AU - Antonarakis, Emmanuel S

AU - Aparicio, Ana M

AU - Armstrong, Andrew J

AU - Attard, Gerhardt

AU - Beer, Tomasz M

AU - Beltran, Himisha

AU - Bjartell, Anders

AU - Blanchard, Pierre

AU - Briganti, Alberto

AU - Bristow, Rob G

AU - Bulbul, Muhammad

AU - Caffo, Orazio

AU - Castellano, Daniel

AU - Castro, Elena

AU - Cheng, Heather H

AU - Chi, Kim N

AU - Chowdhury, Simon

AU - Clarke, Caroline S

AU - Clarke, Noel

AU - Daugaard, Gedske

AU - De Santis, Maria

AU - Duran, Ignacio

AU - Eeles, Ros

AU - Efstathiou, Eleni

AU - Efstathiou, Jason

AU - Ngozi Ekeke, Onyeanunam

AU - Evans, Christopher P

AU - Fanti, Stefano

AU - Feng, Felix Y

AU - Fonteyne, Valerie

AU - Fossati, Nicola

AU - Frydenberg, Mark

AU - George, Daniel

AU - Gleave, Martin

AU - Gravis, Gwenaelle

AU - Halabi, Susan

AU - Heinrich, Daniel

AU - Herrmann, Ken

AU - Higano, Celestia

AU - Hofman, Michael S

AU - Horvath, Lisa G

AU - Hussain, Maha

AU - Jereczek-Fossa, Barbara Alicja

AU - Jones, Robert

AU - Kanesvaran, Ravindran

AU - Kellokumpu-Lehtinen, Pirkko-Liisa

AU - Khauli, Raja B

AU - Klotz, Laurence

AU - Kramer, Gero

AU - Leibowitz, Raya

AU - Logothetis, Christopher J

AU - Mahal, Brandon A

AU - Maluf, Fernando

AU - Mateo, Joaquin

AU - Matheson, David

AU - Mehra, Niven

AU - Merseburger, Axel

AU - Morgans, Alicia K

AU - Morris, Michael J

AU - Mrabti, Hind

AU - Mukherji, Deborah

AU - Murphy, Declan G

AU - Murthy, Vedang

AU - Nguyen, Paul L

AU - Oh, William K

AU - Ost, Piet

AU - O'Sullivan, Joe M

AU - Padhani, Anwar R

AU - Pezaro, Carmel

AU - Poon, Darren M C

AU - Pritchard, Colin C

AU - Rabah, Danny M

AU - Rathkopf, Dana

AU - Reiter, Robert E

AU - Rubin, Mark A

AU - Ryan, Charles J

AU - Saad, Fred

AU - Pablo Sade, Juan

AU - Sartor, Oliver A

AU - Scher, Howard I

AU - Sharifi, Nima

AU - Skoneczna, Iwona

AU - Soule, Howard

AU - Spratt, Daniel E

AU - Srinivas, Sandy

AU - Sternberg, Cora N

AU - Steuber, Thomas

AU - Suzuki, Hiroyoshi

AU - Sydes, Matthew R

AU - Taplin, Mary-Ellen

AU - Tilki, Derya

AU - Türkeri, Levent

AU - Turco, Fabio

AU - Uemura, Hiroji

AU - Uemura, Hirotsugu

AU - Ürün, Yüksel

AU - Vale, Claire L

AU - van Oort, Inge

AU - Vapiwala, Neha

AU - Walz, Jochen

AU - Yamoah, Kosj

AU - Ye, Dingwei

AU - Yu, Evan Y

AU - Zapatero, Almudena

AU - Zilli, Thomas

AU - Omlin, Aurelius

N1 - Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

PY - 2023/3

Y1 - 2023/3

N2 - BACKGROUND: Innovations in imaging and molecular characterisation and the evolution of new therapies have improved outcomes in advanced prostate cancer. Nonetheless, we continue to lack high-level evidence on a variety of clinical topics that greatly impact daily practice. To supplement evidence-based guidelines, the 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) surveyed experts about key dilemmas in clinical management.OBJECTIVE: To present consensus voting results for select questions from APCCC 2022.DESIGN, SETTING, AND PARTICIPANTS: Before the conference, a panel of 117 international prostate cancer experts used a modified Delphi process to develop 198 multiple-choice consensus questions on (1) intermediate- and high-risk and locally advanced prostate cancer, (2) biochemical recurrence after local treatment, (3) side effects from hormonal therapies, (4) metastatic hormone-sensitive prostate cancer, (5) nonmetastatic castration-resistant prostate cancer, (6) metastatic castration-resistant prostate cancer, and (7) oligometastatic and oligoprogressive prostate cancer. Before the conference, these questions were administered via a web-based survey to the 105 physician panel members ("panellists") who directly engage in prostate cancer treatment decision-making. Herein, we present results for the 82 questions on topics 1-3.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Consensus was defined as ≥75% agreement, with strong consensus defined as ≥90% agreement.RESULTS AND LIMITATIONS: The voting results reveal varying degrees of consensus, as is discussed in this article and shown in the detailed results in the Supplementary material. The findings reflect the opinions of an international panel of experts and did not incorporate a formal literature review and meta-analysis.CONCLUSIONS: These voting results by a panel of international experts in advanced prostate cancer can help physicians and patients navigate controversial areas of clinical management for which high-level evidence is scant or conflicting. The findings can also help funders and policymakers prioritise areas for future research. Diagnostic and treatment decisions should always be individualised based on patient and cancer characteristics (disease extent and location, treatment history, comorbidities, and patient preferences) and should incorporate current and emerging clinical evidence, therapeutic guidelines, and logistic and economic factors. Enrolment in clinical trials is always strongly encouraged. Importantly, APCCC 2022 once again identified important gaps (areas of nonconsensus) that merit evaluation in specifically designed trials.PATIENT SUMMARY: The Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with health care providers and patients worldwide. At each APCCC, a panel of physician experts vote in response to multiple-choice questions about their clinical opinions and approaches to managing advanced prostate cancer. This report presents voting results for the subset of questions pertaining to intermediate- and high-risk and locally advanced prostate cancer, biochemical relapse after definitive treatment, advanced (next-generation) imaging, and management of side effects caused by hormonal therapies. The results provide a practical guide to help clinicians and patients discuss treatment options as part of shared multidisciplinary decision-making. The findings may be especially useful when there is little or no high-level evidence to guide treatment decisions.

AB - BACKGROUND: Innovations in imaging and molecular characterisation and the evolution of new therapies have improved outcomes in advanced prostate cancer. Nonetheless, we continue to lack high-level evidence on a variety of clinical topics that greatly impact daily practice. To supplement evidence-based guidelines, the 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) surveyed experts about key dilemmas in clinical management.OBJECTIVE: To present consensus voting results for select questions from APCCC 2022.DESIGN, SETTING, AND PARTICIPANTS: Before the conference, a panel of 117 international prostate cancer experts used a modified Delphi process to develop 198 multiple-choice consensus questions on (1) intermediate- and high-risk and locally advanced prostate cancer, (2) biochemical recurrence after local treatment, (3) side effects from hormonal therapies, (4) metastatic hormone-sensitive prostate cancer, (5) nonmetastatic castration-resistant prostate cancer, (6) metastatic castration-resistant prostate cancer, and (7) oligometastatic and oligoprogressive prostate cancer. Before the conference, these questions were administered via a web-based survey to the 105 physician panel members ("panellists") who directly engage in prostate cancer treatment decision-making. Herein, we present results for the 82 questions on topics 1-3.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Consensus was defined as ≥75% agreement, with strong consensus defined as ≥90% agreement.RESULTS AND LIMITATIONS: The voting results reveal varying degrees of consensus, as is discussed in this article and shown in the detailed results in the Supplementary material. The findings reflect the opinions of an international panel of experts and did not incorporate a formal literature review and meta-analysis.CONCLUSIONS: These voting results by a panel of international experts in advanced prostate cancer can help physicians and patients navigate controversial areas of clinical management for which high-level evidence is scant or conflicting. The findings can also help funders and policymakers prioritise areas for future research. Diagnostic and treatment decisions should always be individualised based on patient and cancer characteristics (disease extent and location, treatment history, comorbidities, and patient preferences) and should incorporate current and emerging clinical evidence, therapeutic guidelines, and logistic and economic factors. Enrolment in clinical trials is always strongly encouraged. Importantly, APCCC 2022 once again identified important gaps (areas of nonconsensus) that merit evaluation in specifically designed trials.PATIENT SUMMARY: The Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with health care providers and patients worldwide. At each APCCC, a panel of physician experts vote in response to multiple-choice questions about their clinical opinions and approaches to managing advanced prostate cancer. This report presents voting results for the subset of questions pertaining to intermediate- and high-risk and locally advanced prostate cancer, biochemical relapse after definitive treatment, advanced (next-generation) imaging, and management of side effects caused by hormonal therapies. The results provide a practical guide to help clinicians and patients discuss treatment options as part of shared multidisciplinary decision-making. The findings may be especially useful when there is little or no high-level evidence to guide treatment decisions.

KW - Male

KW - Humans

KW - Prostatic Neoplasms, Castration-Resistant/pathology

KW - Neoplasm Recurrence, Local

KW - Prostatic Neoplasms/drug therapy

U2 - 10.1016/j.eururo.2022.11.002

DO - 10.1016/j.eururo.2022.11.002

M3 - SCORING: Journal article

C2 - 36494221

VL - 83

SP - 267

EP - 293

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 3

ER -