Management of patients with advanced prostate cancer—metastatic and/or castration-resistant prostate cancer: report of the Advanced Prostate Cancer Consensus Conference (APCCC) 2022

Silke Gillessen*, Alberto Bossi, Ian D. Davis, Johann de Bono, Karim Fizazi, Nicholas D. James, Nicolas Mottet, Neal Shore, Eric Small, Matthew Smith, Christopher J. Sweeney, Bertrand Tombal, Emmanuel S. Antonarakis, Ana M. Aparicio, Andrew J. Armstrong, Gerhardt Attard, Tomasz M. Beer, Himisha Beltran, Anders Bjartell, Pierre BlanchardAlberto Briganti, Rob G. Bristow, Muhammad Bulbul, Orazio Caffo, Daniel Castellano, Elena Castro, Heather H. Cheng, Kim N. Chi, Simon Chowdhury, Caroline S. Clarke, Noel Clarke, Gedske Daugaard, Maria De Santis, Ignacio Duran, Ross Eeles, Eleni Efstathiou, Jason Efstathiou, Onyeanunam Ngozi Ekeke, Christopher P. Evans, Stefano Fanti, Felix Y. Feng, Valerie Fonteyne, Nicola Fossati, Mark Frydenberg, Dan George, Martin Gleave, Gwenaelle Gravis, Susan Halabi, Daniel Heinrich, Ken Herrmann, Celestia Higano, Michael S. Hofman, Lisa G. Horvath, Maha Hussain, Barbara A. Jereczek-Fossa, Rob Jones, Ravindran Kanesvaran, Pirkko Liisa Kellokumpu-Lehtinen, Raja B. Khauli, Laurence Klotz, Gero Kramer, Raja Leibowitz, Christopher Logothetis, Brandon Mahal, Fernando Maluf, Joaquin Mateo, David Matheson, Niven Mehra, Axel Merseburger, Alicia K. Morgans, Michael J. Morris, Hind Mrabti, Deborah Mukherji, Declan G. Murphy, Vedang Murthy, Paul L. Nguyen, William K. Oh, Piet Ost, Joe M. O'Sullivan, Anwar R. Padhani, Carmel J. Pezaro, Darren M.C. Poon, Colin C. Pritchard, Danny M. Rabah, Dana Rathkopf, Robert E. Reiter, Mark A. Rubin, Charles J. Ryan, Fred Saad, Juan Pablo Sade, Oliver Sartor, Howard I. Scher, Nima Sharifi, Iwona Skoneczna, Howard Soule, Daniel E. Spratt, Sandy Srinivas, Cora N. Sternberg, Thomas Steuber, Hiroyoshi Suzuki, Matthew R. Sydes, Mary Ellen Taplin, Derya Tilki, Levent Türkeri, Fabio Turco, Hiroji Uemura, Hirotsugu Uemura, Yüksel Ürün, Claire L. Vale, Inge van Oort, Neha Vapiwala, Jochen Walz, Kosj Yamoah, Dingwei Ye, Evan Y. Yu, Almudena Zapatero, Thomas Zilli, Aurelius Omlin

*Corresponding author for this work
13 Citations (Scopus)

Abstract

Background: Innovations in imaging and molecular characterisation together with novel treatment options have improved outcomes in advanced prostate cancer. However, we still lack high-level evidence in many areas relevant to making management decisions in daily clinical practise. The 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) addressed some questions in these areas to supplement guidelines that mostly are based on level 1 evidence. Objective: To present the voting results of the APCCC 2022. Design, setting, and participants: The experts voted on controversial questions where high-level evidence is mostly lacking: locally advanced prostate cancer; biochemical recurrence after local treatment; metastatic hormone-sensitive, non-metastatic, and metastatic castration-resistant prostate cancer; oligometastatic prostate cancer; and managing side effects of hormonal therapy. A panel of 105 international prostate cancer experts voted on the consensus questions. Outcome measurements and statistical analysis: The panel voted on 198 pre-defined questions, which were developed by 117 voting and non-voting panel members prior to the conference following a modified Delphi process. A total of 116 questions on metastatic and/or castration-resistant prostate cancer are discussed in this manuscript. In 2022, the voting was done by a web-based survey because of COVID-19 restrictions. Results and limitations: The voting reflects the expert opinion of these panellists and did not incorporate a standard literature review or formal meta-analysis. The answer options for the consensus questions received varying degrees of support from panellists, as reflected in this article and the detailed voting results are reported in the supplementary material. We report here on topics in metastatic, hormone-sensitive prostate cancer (mHSPC), non-metastatic, castration-resistant prostate cancer (nmCRPC), metastatic castration-resistant prostate cancer (mCRPC), and oligometastatic and oligoprogressive prostate cancer. Conclusions: These voting results in four specific areas from a panel of experts in advanced prostate cancer can help clinicians and patients navigate controversial areas of management for which high-level evidence is scant or conflicting and can help research funders and policy makers identify information gaps and consider what areas to explore further. However, diagnostic and treatment decisions always have to be individualised based on patient characteristics, including the extent and location of disease, prior treatment(s), co-morbidities, patient preferences, and treatment recommendations and should also incorporate current and emerging clinical evidence and logistic and economic factors. Enrolment in clinical trials is strongly encouraged. Importantly, APCCC 2022 once again identified important gaps where there is non-consensus and that merit evaluation in specifically designed trials. Patient summary: The Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with healthcare providers worldwide. At each APCCC, an expert panel votes on pre-defined questions that target the most clinically relevant areas of advanced prostate cancer treatment for which there are gaps in knowledge. The results of the voting provide a practical guide to help clinicians discuss therapeutic options with patients and their relatives as part of shared and multidisciplinary decision-making. This report focuses on the advanced setting, covering metastatic hormone-sensitive prostate cancer and both non-metastatic and metastatic castration-resistant prostate cancer. Twitter summary: Report of the results of APCCC 2022 for the following topics: mHSPC, nmCRPC, mCRPC, and oligometastatic prostate cancer. Take-home message: At APCCC 2022, clinically important questions in the management of advanced prostate cancer management were identified and discussed, and experts voted on pre-defined consensus questions. The report of the results for metastatic and/or castration-resistant prostate cancer is summarised here.

Original languageEnglish
JournalEuropean Journal of Cancer
Volume185
Pages (from-to)178-215
Number of pages38
ISSN0959-8049
DOIs
Publication statusPublished - 05.2023

Research Areas and Centers

  • Research Area: Luebeck Integrated Oncology Network (LION)
  • Centers: University Cancer Center Schleswig-Holstein (UCCSH)

DFG Research Classification Scheme

  • 205-14 Haematology, Oncology
  • 205-23 Reproductive Medicine, Urology

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