Investigative and clinical urology · 2025
Establishing consensus recommendations for metastatic hormone-sensitive prostate cancer in South Korea: A modified Delphi study.
СтатьяConsensus StatementПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Joung Jae Young, Jeong In Gab, Kang Sung Gu, Ko Young Hwii, Koo Kyo Chul, Kim Kwang Hyun, Kim Myung Ki, Kim Soodong, Kim Jeong Hyun, Park Sung-Woo, Park Jae Young, Song Wan, Lee Seung Hwan, Jung Seung Il, Chung Jae Hoon, Jeong Chang Wook, Joo Kwan Joong, Choi Seock Hwan, Choi Se Young, Choo Seol Ho, Ha Hong Koo, Hong Sung Kyu, Hong Sung-Hoo, Hong Jeong Hee, Hong Jun Hyuk, Kim Sun Il, Kwak Cheol, Jeon Seong Soo
Аннотация
PURPOSE: Consensus is lacking among South Korean urologists on the appropriate treatment of metastatic hormone-sensitive prostate cancer (mHSPC). A modified, Delphi-based consensus on managing mHSPC patients was developed to support clinical decision-making.
MATERIALS AND METHODS: Thirty-six questions on mHSPC treatment were developed by an expert committee (five urologists). Nine questions required achievement of consensus (key questions). Twenty-three urologists participated in two rounds of a Delphi survey. Consensus was defined as ≥75% agreement among panelists, with ≥90% agreement representing strong consensus.
RESULTS: Eighteen questions (50.0%) reached strong consensus, 15 (41.7%) reached consensus, and three (8.3%) reached no consensus. Eight key questions (88.9%) reached strong consensus and one (11.1%) reached consensus. Consensus was reached on recommending androgen-deprivation therapy (ADT) intensification, irrespective of disease volume or type, with an androgen receptor pathway inhibitor (ARPI) as the preferred option. Not using docetaxel alone with ADT when an ARPI is available for treatment intensification was recommended (strong consensus). For high-volume mHSPC patients with a pathogenic, speckle-type poxvirus and zinc finger protein mutation, ADT+ARPI was recommended over triplet therapy (strong consensus). Panelists recommended regular imaging every 6-12 months if no ARPI reimbursement restrictions exist, but a 3-month interval (per current reimbursement guidelines) otherwise. ADT+ARPI was the most recommended systemic treatment (strong consensus).
CONCLUSIONS: This Delphi consensus established local consensus on controversial areas of mHSPC management. The findings offer meaningful perspectives that may help shape future treatment strategies and encourage thoughtful reconsideration of reimbursement criteria to align evidence and clinical practice in South Korea.
MATERIALS AND METHODS: Thirty-six questions on mHSPC treatment were developed by an expert committee (five urologists). Nine questions required achievement of consensus (key questions). Twenty-three urologists participated in two rounds of a Delphi survey. Consensus was defined as ≥75% agreement among panelists, with ≥90% agreement representing strong consensus.
RESULTS: Eighteen questions (50.0%) reached strong consensus, 15 (41.7%) reached consensus, and three (8.3%) reached no consensus. Eight key questions (88.9%) reached strong consensus and one (11.1%) reached consensus. Consensus was reached on recommending androgen-deprivation therapy (ADT) intensification, irrespective of disease volume or type, with an androgen receptor pathway inhibitor (ARPI) as the preferred option. Not using docetaxel alone with ADT when an ARPI is available for treatment intensification was recommended (strong consensus). For high-volume mHSPC patients with a pathogenic, speckle-type poxvirus and zinc finger protein mutation, ADT+ARPI was recommended over triplet therapy (strong consensus). Panelists recommended regular imaging every 6-12 months if no ARPI reimbursement restrictions exist, but a 3-month interval (per current reimbursement guidelines) otherwise. ADT+ARPI was the most recommended systemic treatment (strong consensus).
CONCLUSIONS: This Delphi consensus established local consensus on controversial areas of mHSPC management. The findings offer meaningful perspectives that may help shape future treatment strategies and encourage thoughtful reconsideration of reimbursement criteria to align evidence and clinical practice in South Korea.