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.
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.
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.
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.
European urology. 2020 Jan 27 [Epub ahead of print]
Silke Gillessen, Gerhardt Attard, Tomasz M Beer, Himisha Beltran, Anders Bjartell, Alberto Bossi, Alberto Briganti, Rob G Bristow, Kim N Chi, Noel Clarke, Ian D Davis, Johann de Bono, Charles G Drake, Ignacio Duran, Ros Eeles, Eleni Efstathiou, Christopher P Evans, Stefano Fanti, Felix Y Feng, Karim Fizazi, Mark Frydenberg, Martin Gleave, Susan Halabi, Axel Heidenreich, Daniel Heinrich, Celestia Tia S Higano, Michael S Hofman, Maha Hussain, Nicolas James, Ravindran Kanesvaran, Philip Kantoff, Raja B Khauli, Raya Leibowitz, Chris Logothetis, Fernando Maluf, Robin Millman, Alicia K Morgans, Michael J Morris, Nicolas Mottet, Hind Mrabti, Declan G Murphy, Vedang Murthy, William K Oh, Piet Ost, Joe M O'Sullivan, Anwar R Padhani, Chris Parker, Darren M C Poon, Colin C Pritchard, Robert E Reiter, Mack Roach, Mark Rubin, Charles J Ryan, Fred Saad, Juan Pablo Sade, Oliver Sartor, Howard I Scher, Neal Shore, Eric Small, Matthew Smith, Howard Soule, Cora N Sternberg, Thomas Steuber, Hiroyoshi Suzuki, Christopher Sweeney, Matthew R Sydes, Mary-Ellen Taplin, Bertrand Tombal, Levent Türkeri, Inge van Oort, Almudena Zapatero, Aurelius Omlin
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: ., University College London Cancer Institute, London, UK., Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA., Dana-Farber Cancer Institute, Boston, MA, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Department of Urology, Skåne University Hospital, Malmö, Sweden., Genito Urinary Oncology, Prostate Brachytherapy Unit, Goustave Roussy, Paris, France., Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy., 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., BC Cancer, Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada., The Christie and Salford Royal Hospitals, Manchester, UK., Monash University and Eastern Health, Victoria, Australia., The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, Surrey, UK., Division of Haematology/Oncology, Columbia University Medical Center, New York, NY, USA., Department of Medical Oncology, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Cantabria, Spain., The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK., University of Texas MD Anderson Cancer Center, Houston, TX, USA., University of California Davis School of Medicine, Sacramento, CA, USA., Policlinico S.Orsola, Università di Bologna, Italy., University of California San Francisco, San Francisco, CA, USA., Institut Gustave Roussy, University of Paris Sud, Villejuif, France., 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., Urological Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada., Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA., Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Urology, University of Cologne, Cologne, Germany; Department of Urology, Medical University, Vienna, Austria., Department of Oncology, Akershus University Hospital, Lørenskog, Norway., University of Washington, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA., Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia., Robert H. 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