French AFU Cancer Committee Guidelines - Update 2024-2026: Prostate cancer - Management of metastatic disease and castration resistance

Abstract

Purpose of this document: The Oncology Committee of the French Urology Association is proposing updated recommendations for the management of recurrent and/or metastatic prostate cancer (PCa).

Methods: A systematic review of the literature from 2022 to 2024 was conducted by the CCAFU on the therapeutic management of recurrent PCa following local or metastatic treatment, assessing the references based on their level of evidence.

Results: Molecular imaging is the standard approach for assessing recurrence after local treatment and should not delay early salvage treatment. Androgen deprivation therapy (ADT) is the primary treatment option for metastatic PCa. Intensification of ADT, now cononsidered standard care for metastatic PCa, involves incorporating at least one new-generation hormone therapy (ARPI). For patients with high-volume metastatic disease at diagnosis, adding docetaxel to ADT+ARPI may be considered for eligible patients. In castration-resistant PCa (CRPC) patients, poly(ADP) ribose polymerase (PARP) inhibitors and PSMA radioligand therapy are new treatment options. The combination and sequencing of treatmentsare influenced by several factors, including patient and disease characteristics, prior therapies, genomic status, and molecular imaging findings.

Conclusion: This update of French recommendations should help to improve the management recurrent or metastatic PCa patients.

Keywords: Metastasis; Prostate cancer; Recommendations; Recurrence; Treatment.