Management of Patients with Advanced Prostate Cancer: Report from the Advanced Prostate Cancer Consensus Conference 2021

Silke Gillessen¹, Andrew Armstrong², Gert Attard³, Tomasz M Beer⁴, Himisha Beltran⁵, Anders Bjartell⁶, Alberto Bossi⁷, Alberto Briganti⁸, Robert G Bristow⁹, Muhammad Bulbul¹⁰, Orazio Caffo¹¹, Kim N Chi¹², Caroline S Clarke¹³, Noel Clarke¹⁴, Ian D Davis¹⁵, Johann S de Bono¹⁶, Ignacio Duran¹⁷, Ros Eeles¹⁶, Eleni Efstathiou¹⁸, Jason Efstathiou¹⁹, Onyeanunam Ngozi Ekeke²⁰, Christopher P Evans²¹, Stefano Fanti²², Felix Y Feng²³, Karim Fizazi²⁴, Mark Frydenberg²⁵, Dan George²⁶, Martin Gleave²⁷, Susan Halabi²⁸, Daniel Heinrich²⁹, Celesta Higano³⁰, Michael S Hofman³¹, Maha Hussain³², Nick James¹⁶, Robert Jones³³, Ravindran Kanesvaran³⁴, Raja B Khauli³⁵, Laurence Klotz³⁶, Raya Leibowitz³⁷, Chris Logothetis³⁸, Fernando Maluf³⁹, Robin Millman⁴⁰, Alicia K Morgans⁵, Michael J Morris⁴¹, Nicolas Mottet⁴², Hind Mrabti⁴³, Declan G Murphy⁴⁴, Vedang Murthy⁴⁵, William K Oh⁴⁶, Piet Ost⁴⁷, Joe M O'Sullivan⁴⁸, Anwar R Padhani⁴⁹, Chris Parker¹⁶, Darren M C Poon⁵⁰, Colin C Pritchard⁵¹, Danny M Rabah⁵², Dana Rathkopf⁴¹, Rob E Reiter⁵³, Mark Rubin⁵⁴, Charles J Ryan⁵⁵, Fred Saad⁵⁶, Juan P Sade⁵⁷, Oliver Sartor⁵⁸, Howard I Scher⁵⁹, Neal Shore⁶⁰, Iwona Skoneczna⁶¹, Eric Small²³, Matthew Smith⁶², Howard Soule⁶³, Daniel E Spratt⁶⁴, Cora N Sternberg⁶⁵, Hiroyoshi Suzuki⁶⁶, Christopher Sweeney⁵, Matthew R Sydes⁶⁷, Mary-Ellen Taplin⁵, Derya Tilki⁶⁸, Bertrand Tombal⁶⁹, Levent Türkeri⁷⁰, Hiroji Uemura⁷¹, Hirotsugu Uemura⁷², Inge van Oort⁷³, Kosj Yamoah⁷⁴, Dingwei Ye⁷⁵, Almudena Zapatero⁷⁶, Aurelius Omlin⁷⁷

Affiliations

¹ Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Universita della Svizzera Italiana, Lugano, Switzerland; University of Berne, Berne, Switzerland; Division of Cancer Sciences, University of Manchester, Manchester, UK. Electronic address: silke.gillessen@eoc.ch.
² Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.
³ University College London Cancer Institute, London, UK.
⁴ Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
⁵ Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Department of Urology, Skåne University Hospital, Malmö, Sweden.
⁷ Genitourinary Oncology, Prostate Brachytherapy Unit, Gustave Roussy, Paris, France.
⁸ Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
⁹ Division of Cancer Sciences, University of Manchester, Manchester, UK; Christie NHS Trust and CRUK Manchester Institute and Cancer Centre, Manchester, UK.
¹⁰ Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
¹¹ Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy.
¹² BC Cancer, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada.
¹³ Research Department of Primary Care & Population Health, Royal Free Campus, University College London, London, UK.
¹⁴ The Christie and Salford Royal Hospitals, Manchester, UK.
¹⁵ Monash University and Eastern Health, Victoria, Australia.
¹⁶ The Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK.
¹⁷ Department of Medical Oncology, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
¹⁸ Houston Methodist Cancer Center, Houston, TX, USA.
¹⁹ Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
²⁰ Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
²¹ University of California Davis School of Medicine, Sacramento, CA, USA.
²² IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
²³ UCSF Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA, USA.
²⁴ Institut Gustave Roussy, University of Paris Saclay, Villejuif, France.
²⁵ Department of Surgery, Prostate Cancer Research Program, Monash University, Melbourne, Australia.
²⁶ Departments of Medicine and Surgery, Duke Cancer Institute, Duke University, Durham, NC, USA.
²⁷ Urological Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada.
²⁸ Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
²⁹ Department of Oncology and Radiotherapy, Innlandet Hospital Trust, Gjøvik, Norway.
³⁰ University of British Columbia, Vancouver, BC, Canada.
³¹ Prostate Cancer Theranostics and Imaging Centre of Excellence, Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
³² Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
³³ Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.
³⁴ Division of Medical Oncology, National Cancer Centre, Singapore.
³⁵ Department of Urology and the Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon.
³⁶ Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
³⁷ Oncology Institute, Shamir Medical Center and Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
³⁸ Department of Genitourinary Medical Oncology, David H. Koch Centre, MD Anderson Cancer Centre, Houston, TX, USA; Department of Clinical Therapeutics, University of Athens Alexandra Hospital, Athens, Greece.
³⁹ Beneficiência Portuguesa de São Paulo, São Paulo, SP, Brazil; Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
⁴⁰ Patient Advocate, UK.
⁴¹ Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
⁴² University Jean Monnet, St. Etienne, France.
⁴³ National Institute of Oncology, Mohamed V University, Rabat, Morocco.
⁴⁴ Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
⁴⁵ Tata Memorial Centre, Mumbai, India.
⁴⁶ Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA.
⁴⁷ Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium.
⁴⁸ Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK.
⁴⁹ The Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK; Mount Vernon Cancer Centre, London, UK.
⁵⁰ Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong.
⁵¹ Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.
⁵² The Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁵³ University of California-Los Angeles, Los Angeles, CA, USA.
⁵⁴ Bern Center for Precision Medicine and Department for Biomedical Research, Bern, Switzerland.
⁵⁵ Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
⁵⁶ Centre Hospitalier de Université de Montréal, Montreal, Canada.
⁵⁷ Instituto Alexander Fleming, Buenos Aires, Argentina.
⁵⁸ Tulane Cancer Center, New Orleans, LA, USA.
⁵⁹ Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
⁶⁰ Carolina Urologic Research Center, Myrtle Beach, SC, USA.
⁶¹ Rafal Masztak Grochowski Hospital and Maria Sklodowska Curie National Research Institute of Oncology, Warsaw, Poland.
⁶² Massachusetts General Hospital Cancer Center, Boston, MA, USA.
⁶³ Prostate Cancer Foundation, Santa Monica, CA, USA.
⁶⁴ University Hospitals Seidman Cancer Center, Cleveland, OH, USA.
⁶⁵ Englander Institute for Precision Medicine, Weill Cornell Medicine Division of Hematology and Oncology, Meyer Cancer Center, New York Presbyterian Hospital, New York, NY, USA.
⁶⁶ Toho University Sakura Medical Center, Chiba, Japan.
⁶⁷ MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
⁶⁸ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey.
⁶⁹ Cliniques Universitaires Saint Luc, Brussels, Belgium.
⁷⁰ Department of Urology, M.A. Aydınlar Acıbadem University, Altunizade Hospital, Istanbul, Turkey.
⁷¹ Yokohama City University Medical Center, Yokohama, Japan.
⁷² Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan.
⁷³ Radboud University Medical Center, Nijmegen, The Netherlands.
⁷⁴ Department of Radiation Oncology & Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL, USA.
⁷⁵ Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
⁷⁶ Department of Radiation Oncology, Hospital Universitario de La Princesa, Health Research Institute, Madrid, Spain.
⁷⁷ Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.

PMID: 35450732
DOI: 10.1016/j.eururo.2022.04.002

Free article

Meta-Analysis

Management of Patients with Advanced Prostate Cancer: Report from the Advanced Prostate Cancer Consensus Conference 2021

Silke Gillessen et al. Eur Urol. 2022 Jul.

Free article

. 2022 Jul;82(1):115-141.

doi: 10.1016/j.eururo.2022.04.002. Epub 2022 Apr 18.

Authors

Affiliations

¹ Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Universita della Svizzera Italiana, Lugano, Switzerland; University of Berne, Berne, Switzerland; Division of Cancer Sciences, University of Manchester, Manchester, UK. Electronic address: silke.gillessen@eoc.ch.
² Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.
³ University College London Cancer Institute, London, UK.
⁴ Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
⁵ Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Department of Urology, Skåne University Hospital, Malmö, Sweden.
⁷ Genitourinary Oncology, Prostate Brachytherapy Unit, Gustave Roussy, Paris, France.
⁸ Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
⁹ Division of Cancer Sciences, University of Manchester, Manchester, UK; Christie NHS Trust and CRUK Manchester Institute and Cancer Centre, Manchester, UK.
¹⁰ Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
¹¹ Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy.
¹² BC Cancer, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada.
¹³ Research Department of Primary Care & Population Health, Royal Free Campus, University College London, London, UK.
¹⁴ The Christie and Salford Royal Hospitals, Manchester, UK.
¹⁵ Monash University and Eastern Health, Victoria, Australia.
¹⁶ The Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK.
¹⁷ Department of Medical Oncology, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
¹⁸ Houston Methodist Cancer Center, Houston, TX, USA.
¹⁹ Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
²⁰ Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
²¹ University of California Davis School of Medicine, Sacramento, CA, USA.
²² IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
²³ UCSF Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA, USA.
²⁴ Institut Gustave Roussy, University of Paris Saclay, Villejuif, France.
²⁵ Department of Surgery, Prostate Cancer Research Program, Monash University, Melbourne, Australia.
²⁶ Departments of Medicine and Surgery, Duke Cancer Institute, Duke University, Durham, NC, USA.
²⁷ Urological Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada.
²⁸ Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
²⁹ Department of Oncology and Radiotherapy, Innlandet Hospital Trust, Gjøvik, Norway.
³⁰ University of British Columbia, Vancouver, BC, Canada.
³¹ Prostate Cancer Theranostics and Imaging Centre of Excellence, Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
³² Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
³³ Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.
³⁴ Division of Medical Oncology, National Cancer Centre, Singapore.
³⁵ Department of Urology and the Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon.
³⁶ Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
³⁷ Oncology Institute, Shamir Medical Center and Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
³⁸ Department of Genitourinary Medical Oncology, David H. Koch Centre, MD Anderson Cancer Centre, Houston, TX, USA; Department of Clinical Therapeutics, University of Athens Alexandra Hospital, Athens, Greece.
³⁹ Beneficiência Portuguesa de São Paulo, São Paulo, SP, Brazil; Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
⁴⁰ Patient Advocate, UK.
⁴¹ Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
⁴² University Jean Monnet, St. Etienne, France.
⁴³ National Institute of Oncology, Mohamed V University, Rabat, Morocco.
⁴⁴ Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
⁴⁵ Tata Memorial Centre, Mumbai, India.
⁴⁶ Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA.
⁴⁷ Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium.
⁴⁸ Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK.
⁴⁹ The Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK; Mount Vernon Cancer Centre, London, UK.
⁵⁰ Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong.
⁵¹ Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.
⁵² The Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁵³ University of California-Los Angeles, Los Angeles, CA, USA.
⁵⁴ Bern Center for Precision Medicine and Department for Biomedical Research, Bern, Switzerland.
⁵⁵ Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
⁵⁶ Centre Hospitalier de Université de Montréal, Montreal, Canada.
⁵⁷ Instituto Alexander Fleming, Buenos Aires, Argentina.
⁵⁸ Tulane Cancer Center, New Orleans, LA, USA.
⁵⁹ Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
⁶⁰ Carolina Urologic Research Center, Myrtle Beach, SC, USA.
⁶¹ Rafal Masztak Grochowski Hospital and Maria Sklodowska Curie National Research Institute of Oncology, Warsaw, Poland.
⁶² Massachusetts General Hospital Cancer Center, Boston, MA, USA.
⁶³ Prostate Cancer Foundation, Santa Monica, CA, USA.
⁶⁴ University Hospitals Seidman Cancer Center, Cleveland, OH, USA.
⁶⁵ Englander Institute for Precision Medicine, Weill Cornell Medicine Division of Hematology and Oncology, Meyer Cancer Center, New York Presbyterian Hospital, New York, NY, USA.
⁶⁶ Toho University Sakura Medical Center, Chiba, Japan.
⁶⁷ MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
⁶⁸ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey.
⁶⁹ Cliniques Universitaires Saint Luc, Brussels, Belgium.
⁷⁰ Department of Urology, M.A. Aydınlar Acıbadem University, Altunizade Hospital, Istanbul, Turkey.
⁷¹ Yokohama City University Medical Center, Yokohama, Japan.
⁷² Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan.
⁷³ Radboud University Medical Center, Nijmegen, The Netherlands.
⁷⁴ Department of Radiation Oncology & Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL, USA.
⁷⁵ Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
⁷⁶ Department of Radiation Oncology, Hospital Universitario de La Princesa, Health Research Institute, Madrid, Spain.
⁷⁷ Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.

PMID: 35450732
DOI: 10.1016/j.eururo.2022.04.002

Abstract

Background: Innovations in treatments, imaging, and molecular characterisation in advanced prostate cancer have improved outcomes, but various areas of management still lack high-level evidence to inform clinical practice. The 2021 Advanced Prostate Cancer Consensus Conference (APCCC) addressed some of these questions to supplement guidelines that are based on level 1 evidence.

Objective: To present the voting results from APCCC 2021.

Design, setting, and participants: The experts identified three major areas of controversy related to management of advanced prostate cancer: newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC), the use of prostate-specific membrane antigen ligands in diagnostics and therapy, and molecular characterisation of tissue and blood. A panel of 86 international prostate cancer experts developed the programme and the consensus questions.

Outcome measurements and statistical analysis: The panel voted publicly but anonymously on 107 pre-defined questions, which were developed by both voting and non-voting panel members prior to the conference following a modified Delphi process.

Results and limitations: The voting reflected the opinions of 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 reported in the Supplementary material.

Conclusions: These voting results from a panel of experts in advanced prostate cancer can help clinicians and patients to navigate controversial areas of management for which high-level evidence is scant. However, diagnostic and treatment decisions should always be individualised according to patient characteristics, such as the extent and location of disease, prior treatment(s), comorbidities, patient preferences, and treatment recommendations, and should also incorporate current and emerging clinical evidence and logistic and economic constraints. Enrolment in clinical trials should be strongly encouraged. Importantly, APCCC 2021 once again identified salient questions that merit evaluation in specifically designed trials.

Patient summary: The Advanced Prostate Cancer Consensus Conference is a forum for discussing current diagnosis and treatment options for patients with advanced prostate cancer. An expert panel votes on predefined questions focused on the most clinically relevant areas for treatment of advanced prostate cancer for which there are gaps in knowledge. The voting results provide a practical guide to help clinicians in discussing treatment options with patients as part of shared decision-making.

Keywords: (177)Lu-PSMA therapy; Advanced prostate cancer; Castration-resistant prostate cancer; Genetics; Hormone-sensitive prostate cancer; Imaging; Next-generation sequencing; PARP inhibition; Prostate cancer treatment; Tumour genomic profiling.

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Management of Patients with Advanced Prostate Cancer: Report from the Advanced Prostate Cancer Consensus Conference 2021

Affiliations

Management of Patients with Advanced Prostate Cancer: Report from the Advanced Prostate Cancer Consensus Conference 2021

Authors

Affiliations

Abstract

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LinkOut - more resources

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Medical

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