Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Apr;14(4):E137-E149.
doi: 10.5489/cuaj.6082. Epub 2019 Nov 5.

Controversial issues in the management of patients with advanced prostate cancer: Results from a Canadian consensus forum

Fred Saad  1 , Christina Canil  2 , Antonio Finelli  3 , Sebastien J Hotte  4 , Shawn Malone  2 , Bobby Shayegan  5 , Alan I So  6 , Lorne Aaron  7 , Naveen S Basappa  8 , Henry J Conter  9 , Brita Danielson  8 , Geoffrey Gotto  10 , Robert J Hamilton  3 , Jason P Izard  11 , Anil Kapoor  5 , Michael Kolinsky  8 , Aly-Khan A Lalani  4 , Jean-Baptiste Lattouf  1 , Christopher Morash  2 , Scott C Morgan  2 , Tamim Niazi  12 , Krista L Noonan  13 , Michael Ong  2 , Ricardo A Rendon  14 , Sandeep Sehdev  2 , Huong Hew  15 , Laura Park-Wyllie  15 , Kim N Chi  13
Affiliations
Review

Controversial issues in the management of patients with advanced prostate cancer: Results from a Canadian consensus forum

Fred Saad et al. Can Urol Assoc J. 2020 Apr.

Abstract

Introduction: The management of advanced prostate cancer (PCa) continues to evolve with the emergence of new diagnostic and therapeutic strategies. As a result, there are multiple areas in this landscape with a lack of high-level evidence to guide practice. Consensus initiatives are an approach to establishing practice guidance in areas where evidence is unclear. We conducted a Canadian-based consensus forum to address key controversial areas in the management of advanced PCa.

Methods: As part of a modified Delphi process, a core scientific group of PCa physicians (n=8) identified controversial areas for discussion and developed an initial set of questions, which were then reviewed and finalized with a larger group of 29 multidisciplinary PCa specialists. The main areas of focus were non-metastatic castration-resistant prostate cancer (nmCRPC), metastatic castration-sensitive prostate cancer (mCSPC), metastatic castration-resistant prostate cancer (mCRPC), oligometastatic prostate cancer, genetic testing in prostate cancer, and imaging in advanced prostate cancer. The predetermined threshold for consensus was set at 74% (agreement from 20 of 27 participating physicians).

Results: Consensus participants included uro-oncologists (n=13), medical oncologists (n=10), and radiation oncologists (n=4). Of the 64 questions, consensus was reached in 30 questions (n=5 unanimously). Consensus was more common for questions related to biochemical recurrence, sequencing of therapies, and mCRPC.

Conclusions: A Canadian consensus forum in PCa identified areas of agreement in nearly 50% of questions discussed. Areas of variability may represent opportunities for further research, education, and sharing of best practices. These findings reinforce the value of multidisciplinary consensus initiatives to optimize patient care.

PubMed Disclaimer

Conflict of interest statement

Competing interests: Dr. Saad has served as a consultant for, and received funding from, Amgen, Astellas, AstraZeneca, Bayer, BMS, Janssen, and Sanofi. Dr. Canil has been an advisory board member for AstraZeneca, Bayer, BMS, Eisai, Janssen, Merck, Novartis, and Pfizer; has received travel grants from Amgen and Sanofi; has received consulting honoraria from Janssen; and has participated in clinical trials supported by Astellas, AstraZeneca, Eisai, Janssen, and Roche. Dr. Finelli has been an advisory board member for Abbvie, Astellas, Bayer, Janssen, Ipsen, Sanofi, and TerSera; and has participated in clinical trials supported by Astellas, Bayer, and Janssen. Dr. Hotte has received institutional research funding or consulting honoraria from Astellas, Bayer, and Janssen. Dr. Malone has served on advisory boards and/or received honoraria from Abbvie, Astellas, Bayer, Janssen, Sanofi, and TerSera; and has participated in clinical trials sponsored by Bayer and Janssen. Dr. Shayegan has received grants or honoraria from Abbvie, Astellas, Janssen, and Sanofi; and has participated in clinical trials sponsored by Astellas and Janssen. Dr. So has received honoraria from and served on advisory boards for Abbvie, Amgen, Astellas, Bayer, Ferring, Janssen, and Sanofi; and has participated in clinical trials sponsored by Astellas and Janssen. Dr. Aaron has attended advisory boards for Abbvie and Janssen; has been a speaker for Ferring and Janssen; holds investments in Johnson & Johnson; and has participated in clinical trials supported by Astellas, Ferring, and Janssen. Dr. Basappa has served on advisory boards for and received honoraria and/or grants from Astellas, AstraZeneca, Bayer, BMS, Eisai, Ipsen, Janssen, Merck, Pfizer, and Roche. Dr. Conter has received grants and/or honoraria from Astellas, BMS, Eli Lilly, Janssen, and Novartis; and has participated in clinical trials sponsored by AstraZeneca, Merck, Pfizer, Roche, and Takeda. Dr. Danielson has received advisory board honoraria and speaker fees from Amgen, Astellas, Bayer, and Janssen. Dr. Gotto has received honoraria and served on advisory boards for Amgen, Astellas, Astra Zeneca, Bayer, Janssen, Merck, Roche, and Sanofi; and has participated in clinical trials sponsored by Amgen, Astellas, Astra Zeneca, Bayer, Janssen, and Myovant. Dr. Hamilton has served on advisory boards for and/or received honoraria from Abbvie, Amgen, Astellas, Bayer, Janssen, and TerSera; and has participated in clinical trials sponsored by Bayer and Janssen. Dr. Izard has been an advisory board member or consultant for Abbvie, Astellas, Ferring, Janssen, and Sanofi; and has participated in clinical trials supported by Astellas, AstraZeneca, and Merck. Dr. Kapoor has attended advisory boards for and participated in clinical trials supported by Amgen, Astellas, Janssen, GSK, Novartis, Pfizer, and Sanofi. Dr. Kolinsky has been a consultant for Janssen; has received honoraria and travel reimbursement from Astellas, AstraZeneca, BMS, Ipsen, Janssen, Merck, and Novartis; and has participated in clinical trials supported by Astellas, AstraZeneca, BMS, GSK, Ipsen, Janssen, Merck, and Roche. Dr. Lalani has received honoraria for ad hoc consultation or advisory board meetings from BMS, Eisai, Ipsen, Merck, Pfizer, Roche, and TerSera; and has participated in clinical trials supported by Merck. Dr. Lattouf has attended advisory boards Abbvie, Amgen, Astellas, Novartis, and Pfizer; and has received an educational grant from Janssen. Dr. Morash has attended advisory boards for Abbvie, Astellas, Ferring, Janssen, and Sanofi; and has participated in clinical trials supported by Abbvie (CRONOS II). Dr. Morgan has attended advisory boards for and received honoraria from Astellas, Bayer, and Janssen; and has participated in clinical trials supported by Janssen. Dr. Niazi has received research grants and honoraria from Abbvie, Amgen, Astellas, Astra Zeneca, Bayer, Janssen, and Sanofi; and has participated in clinical trials supported by Astellas, Ferring, Janssen, and Sanofi. Dr. Noonan has been an advisory board member for Astellas, BMS, Janssen, Pfizer, and Sanofi; and has participated in clinical trials supported by Astellas. Dr. Ong has received honoraria from Astellas, AstraZeneca, Bayer, BMS, EMD Serono, Janssen, and Merck; and received a research grant from AstraZeneca and a GUMOC grant from Astellas. Dr. Rendon has attended advisory boards and has been a speaker for Amgen, Astellas, Ferring, and Janssen. Dr. Shayegan has received grants/honoraria from Abbvie, Astellas, Janssen, and Sanofi; and has participated in clinical trials supported by Astellas and Janssen. Dr. Sehdev has participated in advisory boards for Astellas, AstraZeneca, Bayer, and Janssen. Mr. Hew and Ms. Park-Wyllie are employed by Janssen Canada. Dr. Chi has served on advisory boards and received honoraria and/or grant funding from Astellas, Bayer, Janssen, Roche, and Sanofi.

Figures

Fig. 1
Fig. 1
The modified Delphi process used for the consensus forum.
Fig. 2
Fig. 2
Various sequencing combinations. CRPC: castration-resistance prostate cancer; CSPC: castration-sensitive prostate cancer; m: metastatic; nm: nonmetastatic; pt: patient.
See this image and copyright information in PMC

References

    1. Cronin KA, Lake AJ, Scott S, et al. Annual report to the nation on the status of cancer, part I: National cancer statistics. Cancer. 2018;124:2785–800. doi: 10.1002/cncr.31551. - DOI - PMC - PubMed
    1. Gillessen S, Attard G, Beer TM, et al. Management of patients with advanced prostate cancer: The report of the advanced prostate cancer consensus conference APCCC 2017. Eur Urol. 2018;73:178–211. doi: 10.1016/j.eururo.2017.08.014. - DOI - PubMed
    1. Morgans AK, van Bommel AC, Stowell C, et al. Development of a standardized set of patient-centered outcomes for advanced prostate cancer: An international effort for a unified approach. Eur Urol. 2015;68:891–8. doi: 10.1016/j.eururo.2015.06.007. - DOI - PubMed
    1. Diamond IR, Grant RC, Feldman BM, et al. Defining consensus: A systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol. 2014;67:401–9. doi: 10.1016/j.jclinepi.2013.12.002. - DOI - PubMed
    1. Jones J, Hunter D. Consensus methods for medical and health services research. BMJ. 1995;311:376–80. doi: 10.1136/bmj.311.7001.376. - DOI - PMC - PubMed