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Eur J Cancer. 2014 Jun;50(9):1617-27. doi: 10.1016/j.ejca.2014.03.010. Epub 2014 Apr 3.

Optimal management of metastatic castration-resistant prostate cancer: highlights from a European Expert Consensus Panel.

Author information

1
Irish Cancer Society and University College, Dublin, Ireland. Electronic address: jfitzpatrick@irishcancer.ie.
2
University Hospital del Mar, Barcelona, Spain.
3
Institut Gustave Roussy, University of Paris Sud, Villejuif, France.
4
University Hospital Aachen, Aachen, Germany.
5
San Camillo and Forlanini Hospital, Rome, Italy.
6
Centre du Cancer et Institut de Recherche Expérimental et Clinique (IREC), Cliniques Universitaires Saint Luc, Brussels, Belgium.
7
Hospital Clinic de Barcelona, Barcelona, Spain.
8
University Hospitals Bristol, Bristol, United Kingdom.
9
Ospedale San Donato, Istituto Toscano Tumori (ITT), Arezzo, Italy.
10
University Federico II, Napoli, Italy.
11
University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States.
12
St. James's Hospital and Trinity College, Dublin, Ireland.
13
Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
14
Kantonsspital St. Gallen, St. Gallen, Switzerland.
15
Tampere University Hospital, Tampere, Finland.
16
Georges Pompidou European Hospital, Paris, France.
17
Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
18
Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.
19
Ludwig Boltzmann Institute for Applied Cancer Research, Kaiser Franz Josef-Spital, Vienna, Austria.
20
Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
21
Erasmus University Medical Center, Rotterdam, The Netherlands.

Abstract

The exponential growth of novel therapies for the treatment of metastatic castration-resistant prostate cancer (mCRPC) over the last decade has created an acute need for education and guidance of clinicians regarding optimal strategies for patient management. A multidisciplinary panel of 21 European experts in mCRPC assembled for comprehensive discussion and consensus development, seeking to move the field forward and provide guidance and perspectives on optimal selection and sequencing of therapeutic agents and monitoring of response to treatment and disease progression. A total of 110 clinically-relevant questions were addressed and a modified Delphi method was utilised to obtain a consensus. The panel reached a consensus on several important issues, providing recommendations on appropriate phase III clinical trial end-points and optimal strategies for imaging and monitoring of bone metastases. Guidance regarding selection and sequencing of therapy in patients with newly diagnosed or progressive mCRPC is emphasised, including the use of novel bone-targeted agents, chemotherapy, androgen receptor pathway-targeted agents and immunotherapy. The impact of drug resistance and prostate-specific antigen flare on treatment decisions was also addressed. Ultimately, individualised therapy for patients with mCRPC is dependent on continued refinement of clinical decision-making based on patient and disease characteristics. This consensus statement offers clinicians expert guidance on the implementation of recent advances to improve patient outcome, focusing on the future of prostate cancer care.

KEYWORDS:

Abiraterone; Cabazitaxel; Circulating tumour cells; Consensus; Denosumab; Docetaxel; Enzalutamide; Metastatic castration-resistant prostate cancer; Radium 223 dichloride; Sipuleucel-T

PMID:
24703899
DOI:
10.1016/j.ejca.2014.03.010
[Indexed for MEDLINE]
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