Format

Send to

Choose Destination
Eur Urol. 2020 Apr;77(4):508-547. doi: 10.1016/j.eururo.2020.01.012. Epub 2020 Jan 27.

Management of Patients with Advanced Prostate Cancer: Report of the Advanced Prostate Cancer Consensus Conference 2019.

Author information

1
Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Universita della Svizzera Italiana, Lugano, Switzerland; Cantonal Hospital, St. Gallen, Switzerland; University of Bern, Bern, Switzerland; Division of Cancer Science, University of Manchester, Manchester, UK. Electronic address: silke.gillessen@eoc.ch.
2
University College London Cancer Institute, London, UK.
3
Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
4
Dana-Farber Cancer Institute, Boston, MA, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
5
Department of Urology, Skåne University Hospital, Malmö, Sweden.
6
Genito Urinary Oncology, Prostate Brachytherapy Unit, Goustave Roussy, Paris, France.
7
Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
8
Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Christie NHS Trust, Manchester, UK; CRUK Manchester Institute and Cancer Centre, Manchester, UK.
9
BC Cancer, Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada.
10
The Christie and Salford Royal Hospitals, Manchester, UK.
11
Monash University and Eastern Health, Victoria, Australia.
12
The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, Surrey, UK.
13
Division of Haematology/Oncology, Columbia University Medical Center, New York, NY, USA.
14
Department of Medical Oncology, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Cantabria, Spain.
15
The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK.
16
University of Texas MD Anderson Cancer Center, Houston, TX, USA.
17
University of California Davis School of Medicine, Sacramento, CA, USA.
18
Policlinico S.Orsola, Università di Bologna, Italy.
19
University of California San Francisco, San Francisco, CA, USA.
20
Institut Gustave Roussy, University of Paris Sud, Villejuif, France.
21
Department of Surgery, Monash University, Melbourne, Australia; Prostate Cancer Research Program, Monash University, Melbourne, Australia; Department Anatomy & Developmental Biology, Faculty of Nursing, Medicine & Health Sciences, Monash University, Melbourne, Australia.
22
Urological Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada.
23
Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
24
Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Urology, University of Cologne, Cologne, Germany; Department of Urology, Medical University, Vienna, Austria.
25
Department of Oncology, Akershus University Hospital, Lørenskog, Norway.
26
University of Washington, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
27
Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
28
Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
29
The Institute of Cancer Research, London, UK.
30
Division of Medical Oncology, National Cancer Centre, Singapore.
31
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
32
Department of Urology, American University of Beirut Medical Center, Beirut, Lebanon; Naef K. Basile Cancer Institute (NKBCI), American University of Beirut Medical Center, Beirut, Lebanon.
33
Oncology institute, Shamir Medical Center and Faculty of medicine, Tel-Aviv University, Israel.
34
Department of Genitourinary Medical Oncology, MD Anderson Cancer Centre, Houston, TX, USA; Department of Clinical Therapeutics, David H. Koch Centre, University of Athens Alexandra Hospital, Athens, Greece.
35
Beneficiência Portuguesa de São Paulo, São Paulo, SP, Brazil; Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
36
UK.
37
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
38
University Hospital Nord, St Etienne, France.
39
National Institute of Oncology, University hospital, Rabat, Morocco.
40
Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
41
Tata Memorial Centre, Mumbai, India.
42
Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA.
43
Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
44
Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK; Radiotherapy Department, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland, UK.
45
Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK.
46
Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK.
47
Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong.
48
Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
49
University of California Los Angeles, Los Angeles, CA, USA.
50
UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
51
Bern Center for Precision Medicine, Bern, Switzerland; Department for Biomedical Research, University of Bern, Bern, Switzerland.
52
Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
53
Centre Hospitalier de Université de Montréal, Montreal, Canada.
54
Instituto Alexander Fleming, Buenos Aires, Argentina.
55
Tulane Cancer Center, New Orleans, LA, USA.
56
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.
57
Carolina Urologic Research Center, Myrtle Beach, SC, USA.
58
Massachusetts General Hospital Cancer Center, Boston, MA, USA.
59
Prostate Cancer Foundation, Santa Monica, CA, USA.
60
Division of Hematology and Oncology, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.
61
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
62
Toho University Sakura Medical Center, Chiba, Japan.
63
MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
64
Cliniques Universitaires Saint Luc, Brussels, Belgium.
65
Department of Urology, M.A. Aydınlar Acıbadem University, Altunizade Hospital, Istanbul, Turkey.
66
Radboud University Medical Center, Nijmegen, The Netherlands.
67
Department of Radiation Oncology, University Hospital La Princesa, Health Research Institute, Madrid, Spain.
68
University of Bern, Bern, Switzerland; Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.

Abstract

BACKGROUND:

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.

OBJECTIVE:

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.

CONCLUSIONS:

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.

PATIENT SUMMARY:

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.

KEYWORDS:

Advanced prostate cancer; Castration-naïve prostate cancer; Castration-resistant prostate cancer; Genetics; High-risk localised prostate cancer; Hormone-sensitive prostate cancer; Imaging; Oligometastatic prostate cancer; Overall survival; Progression-free survival; Prostate cancer treatment; Tumour genomic profiling

PMID:
32001144
DOI:
10.1016/j.eururo.2020.01.012
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center