Management of Patients with Advanced Prostate Cancer: Report of the Advanced Prostate Cancer Consensus Conference 2019
Journal Paper/Review - Jan 27, 2020
Omlin Aurelius, Ryan Charles J, Rubin Mark, Roach Mack, Reiter Robert E, Pritchard Colin C, Poon Darren M C, Parker Chris, Padhani Anwar R, O'Sullivan Joe M, Ost Piet, Oh William K, Murthy Vedang, Murphy Declan G, Mrabti Hind, Mottet Nicolas, Morris Michael J, Saad Fred, Sade Juan Pablo, Zapatero Almudena, van Oort Inge, Türkeri Levent, Tombal Bertrand, Taplin Mary-Ellen, Sydes Matthew R, Sweeney Christopher, Suzuki Hiroyoshi, Steuber Thomas, Sternberg Cora N, Soule Howard, Smith Matthew, Small Eric, Shore Neal, Scher Howard I, Sartor Oliver, Morgans Alicia K, Millman Robin, Evans Christopher P, Efstathiou Eleni, Eeles Ros, Duran Ignacio, Drake Charles G, de Bono Johann, Davis Ian D, Clarke Noel, Chi Kim N, Bristow Rob G, Briganti Alberto, Bossi Alberto, Bjartell Anders, Beltran Himisha, Beer Tomasz M, Attard Gerhardt, Fanti Stefano, Feng Felix Y, Maluf Fernando, Logothetis Chris, Leibowitz Raya, Khauli Raja B, Kantoff Philip, Kanesvaran Ravindran, James Nicolas, Hussain Maha, Hofman Michael S, Higano Celestia Tia S, Heinrich Daniel, Heidenreich Axel, Halabi Susan, Gleave Martin, Frydenberg Mark, Fizazi Karim, Gillessen Silke
Innovations in treatments, imaging, and molecular characterisation in advanced prostate cancer have improved outcomes, but there are still many aspects of management that lack high-level evidence to inform clinical practice. The Advanced Prostate Cancer Consensus Conference (APCCC) 2019 addressed some of these topics to supplement guidelines that are based on level 1 evidence.
To present the results from the APCCC 2019.
DESIGN, SETTING, AND PARTICIPANTS
Similar to prior conferences, experts identified 10 important areas of controversy regarding the management of advanced prostate cancer: locally advanced disease, biochemical recurrence after local therapy, treating the primary tumour in the metastatic setting, metastatic hormone-sensitive/naïve prostate cancer, nonmetastatic castration-resistant prostate cancer, metastatic castration-resistant prostate cancer, bone health and bone metastases, molecular characterisation of tissue and blood, inter- and intrapatient heterogeneity, and adverse effects of hormonal therapy and their management. A panel of 72 international prostate cancer experts developed the programme and the consensus questions.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
The panel voted publicly but anonymously on 123 predefined questions, which were developed by both voting and nonvoting panel members prior to the conference following a modified Delphi process.
RESULTS AND LIMITATIONS
Panellists voted based on their opinions rather than a standard literature review or formal meta-analysis. The answer options for the consensus questions had varying degrees of support by the panel, as reflected in this article and the detailed voting results reported in the Supplementary material.
These voting results from a panel of prostate cancer experts can help clinicians and patients navigate controversial areas of advanced prostate management for which high-level evidence is sparse. However, diagnostic and treatment decisions should always be individualised based on patient-specific factors, such as disease extent and location, prior lines of therapy, comorbidities, and treatment preferences, together with current and emerging clinical evidence and logistic and economic constraints. Clinical trial enrolment for men with advanced prostate cancer should be strongly encouraged. Importantly, APCCC 2019 once again identified important questions that merit assessment in specifically designed trials.
The Advanced Prostate Cancer Consensus Conference provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference, which has been held three times since 2015, aims to share the knowledge of world experts in prostate cancer management with health care providers worldwide. At the end of the conference, an expert panel discusses and votes on predefined consensus questions that target the most clinically relevant areas of advanced prostate cancer treatment. The results of the voting provide a practical guide to help clinicians discuss therapeutic options with patients as part of shared and multidisciplinary decision making.