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. 2023 Mar;83(3):267-293.
doi: 10.1016/j.eururo.2022.11.002. Epub 2022 Dec 6.

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

Silke Gillessen  1 Alberto Bossi  2 Ian D Davis  3 Johann de Bono  4 Karim Fizazi  5 Nicholas D James  6 Nicolas Mottet  7 Neal Shore  8 Eric Small  9 Mathew Smith  10 Christopher Sweeney  11 Bertrand Tombal  12 Emmanuel S Antonarakis  13 Ana M Aparicio  14 Andrew J Armstrong  15 Gerhardt Attard  16 Tomasz M Beer  17 Himisha Beltran  18 Anders Bjartell  19 Pierre Blanchard  20 Alberto Briganti  21 Rob G Bristow  22 Muhammad Bulbul  23 Orazio Caffo  24 Daniel Castellano  25 Elena Castro  26 Heather H Cheng  27 Kim N Chi  28 Simon Chowdhury  29 Caroline S Clarke  30 Noel Clarke  31 Gedske Daugaard  32 Maria De Santis  33 Ignacio Duran  34 Ros Eeles  35 Eleni Efstathiou  36 Jason Efstathiou  37 Onyeanunam Ngozi Ekeke  38 Christopher P Evans  39 Stefano Fanti  40 Felix Y Feng  41 Valerie Fonteyne  42 Nicola Fossati  43 Mark Frydenberg  44 Daniel George  45 Martin Gleave  46 Gwenaelle Gravis  47 Susan Halabi  48 Daniel Heinrich  49 Ken Herrmann  50 Celestia Higano  51 Michael S Hofman  52 Lisa G Horvath  53 Maha Hussain  54 Barbara Alicja Jereczek-Fossa  55 Robert Jones  56 Ravindran Kanesvaran  57 Pirkko-Liisa Kellokumpu-Lehtinen  58 Raja B Khauli  59 Laurence Klotz  60 Gero Kramer  61 Raya Leibowitz  62 Christopher J Logothetis  63 Brandon A Mahal  64 Fernando Maluf  65 Joaquin Mateo  66 David Matheson  67 Niven Mehra  68 Axel Merseburger  69 Alicia K Morgans  18 Michael J Morris  70 Hind Mrabti  71 Deborah Mukherji  72 Declan G Murphy  73 Vedang Murthy  74 Paul L Nguyen  75 William K Oh  76 Piet Ost  77 Joe M O'Sullivan  78 Anwar R Padhani  79 Carmel Pezaro  80 Darren M C Poon  81 Colin C Pritchard  82 Danny M Rabah  83 Dana Rathkopf  70 Robert E Reiter  84 Mark A Rubin  85 Charles J Ryan  13 Fred Saad  86 Juan Pablo Sade  87 Oliver A Sartor  88 Howard I Scher  89 Nima Sharifi  90 Iwona Skoneczna  91 Howard Soule  92 Daniel E Spratt  93 Sandy Srinivas  94 Cora N Sternberg  95 Thomas Steuber  96 Hiroyoshi Suzuki  97 Matthew R Sydes  98 Mary-Ellen Taplin  11 Derya Tilki  99 Levent Türkeri  100 Fabio Turco  101 Hiroji Uemura  102 Hirotsugu Uemura  103 Yüksel Ürün  104 Claire L Vale  105 Inge van Oort  106 Neha Vapiwala  107 Jochen Walz  108 Kosj Yamoah  109 Dingwei Ye  110 Evan Y Yu  111 Almudena Zapatero  112 Thomas Zilli  113 Aurelius Omlin  114
Affiliations

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

Silke Gillessen et al. Eur Urol. 2023 Mar.

Abstract

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.

Keywords: Adjuvant therapy; Biochemical recurrence; Hormonal treatment; Locally advanced prostate cancer; Next-generation imaging; Prostate cancer; Prostate-specific membrane antigen positron emission tomography imaging; Salvage radiation therapy; Salvage therapy; Side effects.

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References

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