Management of patients with advanced prostate cancer-metastatic and/or castration-resistant prostate cancer: Report of the Advanced Prostate Cancer Consensus Conference (APCCC) 2022.
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Gillessen Silke, Bossi Alberto, Davis Ian D, de Bono Johann, Fizazi Karim, James Nicholas D, Mottet Nicolas, Shore Neal, Small Eric, Smith Matthew, Sweeney Christopher J, Tombal Bertrand, Antonarakis Emmanuel S, Aparicio Ana M, Armstrong Andrew J, Attard Gerhardt, Beer Tomasz M, Beltran Himisha, Bjartell Anders, Blanchard Pierre, Briganti Alberto, Bristow Rob G, Bulbul Muhammad, Caffo Orazio, Castellano Daniel, Castro Elena, Cheng Heather H, Chi Kim N, Chowdhury Simon, Clarke Caroline S, Clarke Noel, Daugaard Gedske, De Santis Maria, Duran Ignacio, Eeles Ross, Efstathiou Eleni, Efstathiou Jason, Ekeke Onyeanunam Ngozi, Evans Christopher P, Fanti Stefano, Feng Felix Y, Fonteyne Valerie, Fossati Nicola, Frydenberg Mark, George Dan, Gleave Martin, Gravis Gwenaelle, Halabi Susan, Heinrich Daniel, Herrmann Ken, Higano Celestia, Hofman Michael S, Horvath Lisa G, Hussain Maha, Jereczek-Fossa Barbara A, Jones Rob, Kanesvaran Ravindran, Kellokumpu-Lehtinen Pirkko-Liisa, Khauli Raja B, Klotz Laurence, Kramer Gero, Leibowitz Raja, Logothetis Christopher, Mahal Brandon, Maluf Fernando, Mateo Joaquin, Matheson David, Mehra Niven, Merseburger Axel, Morgans Alicia K, Morris Michael J, Mrabti Hind, Mukherji Deborah, Murphy Declan G, Murthy Vedang, Nguyen Paul L, Oh William K, Ost Piet, O'Sullivan Joe M, Padhani Anwar R, Pezaro Carmel J, Poon Darren M C, Pritchard Colin C, Rabah Danny M, Rathkopf Dana, Reiter Robert E, Rubin Mark A, Ryan Charles J, Saad Fred, Sade Juan Pablo, Sartor Oliver, Scher Howard I, Sharifi Nima, Skoneczna Iwona, Soule Howard, Spratt Daniel E, Srinivas Sandy, Sternberg Cora N, Steuber Thomas, Suzuki Hiroyoshi, Sydes Matthew R, Taplin Mary-Ellen, Tilki Derya, Türkeri Levent, Turco Fabio, Uemura Hiroji, Uemura Hirotsugu, Ürün Yüksel, Vale Claire L, van Oort Inge, Vapiwala Neha, Walz Jochen, Yamoah Kosj, Ye Dingwei, Yu Evan Y, Zapatero Almudena, Zilli Thomas, Omlin Aurelius
Аннотация
OBJECTIVE: To present the voting results of the APCCC 2022.
DESIGN, SETTING, AND PARTICIPANTS: The experts voted on controversial questions where high-level evidence is mostly lacking: locally advanced prostate cancer; biochemical recurrence after local treatment; metastatic hormone-sensitive, non-metastatic, and metastatic castration-resistant prostate cancer; oligometastatic prostate cancer; and managing side effects of hormonal therapy. A panel of 105 international prostate cancer experts voted on the consensus questions.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The panel voted on 198 pre-defined questions, which were developed by 117 voting and non-voting panel members prior to the conference following a modified Delphi process. A total of 116 questions on metastatic and/or castration-resistant prostate cancer are discussed in this manuscript. In 2022, the voting was done by a web-based survey because of COVID-19 restrictions.
RESULTS AND LIMITATIONS: The voting reflects the expert opinion of these panellists and did not incorporate a standard literature review or formal meta-analysis. The answer options for the consensus questions received varying degrees of support from panellists, as reflected in this article and the detailed voting results are reported in the supplementary material. We report here on topics in metastatic, hormone-sensitive prostate cancer (mHSPC), non-metastatic, castration-resistant prostate cancer (nmCRPC), metastatic castration-resistant prostate cancer (mCRPC), and oligometastatic and oligoprogressive prostate cancer.
CONCLUSIONS: These voting results in four specific areas from a panel of experts in advanced prostate cancer can help clinicians and patients navigate controversial areas of management for which high-level evidence is scant or conflicting and can help research funders and policy makers identify information gaps and consider what areas to explore further. However, diagnostic and treatment decisions always have to be individualised based on patient characteristics, including the extent and location of disease, prior treatment(s), co-morbidities, patient preferences, and treatment recommendations and should also incorporate current and emerging clinical evidence and logistic and economic factors. Enrolment in clinical trials is strongly encouraged. Importantly, APCCC 2022 once again identified important gaps where there is non-consensus and 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 healthcare providers worldwide. At each APCCC, an expert panel votes on pre-defined questions that target the most clinically relevant areas of advanced prostate cancer treatment for which there are gaps in knowledge. The results of the voting provide a practical guide to help clinicians discuss therapeutic options with patients and their relatives as part of shared and multidisciplinary decision-making. This report focuses on the advanced setting, covering metastatic hormone-sensitive prostate cancer and both non-metastatic and metastatic castration-resistant prostate cancer.
TWITTER SUMMARY: Report of the results of APCCC 2022 for the following topics: mHSPC, nmCRPC, mCRPC, and oligometastatic prostate cancer.
TAKE-HOME MESSAGE: At APCCC 2022, clinically important questions in the management of advanced prostate cancer management were identified and discussed, and experts voted on pre-defined consensus questions. The report of the results for metastatic and/or castration-resistant prostate cancer is summarised here.