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

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

doi:10.1016/j.eururo.2020.01.012

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

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 FizaziMark 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

Medicine - Hematology, Oncology, Transplant

Research output: Contribution to journal › Article › peer-review

232 Scopus citations

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.

Original language	English (US)
Pages (from-to)	508-547
Number of pages	40
Journal	European Urology
Volume	77
Issue number	4
DOIs	https://doi.org/10.1016/j.eururo.2020.01.012
State	Published - Apr 2020

Bibliographical note

Funding Information:
Although there was a range of opinions regarding the starting dose of chemotherapy in patients of East Asian ethnicity, 60% of panellists recommended starting chemotherapy at a reduced dose. This strategy is supported by the experience of physicians from the Asia-Pacific region and by limited studies. Although no large prospective clinical trials have compared dosing strategies (eg, a reduced dose vs a full dose with G-CSF support) in this population, the available literature suggests that antitumour activity is comparable, even if a reduced dose is used [174,175] .

Publisher Copyright:
© 2020 The Authors

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

PubMed: MeSH publication types

Research Support, Non-U.S. Gov't
Journal Article
Consensus Development Conference

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Publisher link

10.1016/j.eururo.2020.01.012

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Gillessen, S., Attard, G., Beer, T. M., Beltran, H., Bjartell, A., Bossi, A., Briganti, A., Bristow, R. G., Chi, K. N., Clarke, N., Davis, I. D., de Bono, J., Drake, C. G., Duran, I., Eeles, R., Efstathiou, E., Evans, C. P., Fanti, S., Feng, F. Y., ... Omlin, A. (2020). Management of Patients with Advanced Prostate Cancer: Report of the Advanced Prostate Cancer Consensus Conference 2019. European Urology, 77(4), 508-547. https://doi.org/10.1016/j.eururo.2020.01.012

Gillessen, S, Attard, G, Beer, TM, Beltran, H, Bjartell, A, Bossi, A, Briganti, A, Bristow, RG, Chi, KN, Clarke, N, Davis, ID, de Bono, J, Drake, CG, Duran, I, Eeles, R, Efstathiou, E, Evans, CP, Fanti, S, Feng, FY, Fizazi, K, Frydenberg, M, Gleave, M, Halabi, S, Heidenreich, A, Heinrich, D, Higano, CS, Hofman, MS, Hussain, M, James, N, Kanesvaran, R, Kantoff, P, Khauli, RB, Leibowitz, R, Logothetis, C, Maluf, F, Millman, R, Morgans, AK, Morris, MJ, Mottet, N, Mrabti, H, Murphy, DG, Murthy, V, Oh, WK, Ost, P, O'Sullivan, JM, Padhani, AR, Parker, C, Poon, DMC, Pritchard, CC, Reiter, RE, Roach, M, Rubin, M, Ryan, CJ, Saad, F, Sade, JP, Sartor, O, Scher, HI, Shore, N, Small, E, Smith, M, Soule, H, Sternberg, CN, Steuber, T, Suzuki, H, Sweeney, C, Sydes, MR, Taplin, ME, Tombal, B, Türkeri, L, van Oort, I, Zapatero, A & Omlin, A 2020, 'Management of Patients with Advanced Prostate Cancer: Report of the Advanced Prostate Cancer Consensus Conference 2019', European Urology, vol. 77, no. 4, pp. 508-547. https://doi.org/10.1016/j.eururo.2020.01.012

@article{0948df1a48a8464bab2046d97efdb929,

title = "Management of Patients with Advanced Prostate Cancer: Report of the Advanced Prostate Cancer Consensus Conference 2019",

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/na{\"i}ve 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-na{\"i}ve 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",

author = "Silke Gillessen and Gerhardt Attard and Beer, {Tomasz M.} and Himisha Beltran and Anders Bjartell and Alberto Bossi and Alberto Briganti and Bristow, {Rob G.} and Chi, {Kim N.} and Noel Clarke and Davis, {Ian D.} and {de Bono}, Johann and Drake, {Charles G.} and Ignacio Duran and Ros Eeles and Eleni Efstathiou and Evans, {Christopher P.} and Stefano Fanti and Feng, {Felix Y.} and Karim Fizazi and Mark Frydenberg and Martin Gleave and Susan Halabi and Axel Heidenreich and Daniel Heinrich and Higano, {Celestia (Tia) S.} and Hofman, {Michael S.} and Maha Hussain and Nicolas James and Ravindran Kanesvaran and Philip Kantoff and Khauli, {Raja B.} and Raya Leibowitz and Chris Logothetis and Fernando Maluf and Robin Millman and Morgans, {Alicia K.} and Morris, {Michael J.} and Nicolas Mottet and Hind Mrabti and Murphy, {Declan G.} and Vedang Murthy and Oh, {William K.} and Piet Ost and O'Sullivan, {Joe M.} and Padhani, {Anwar R.} and Chris Parker and Poon, {Darren M.C.} and Pritchard, {Colin C.} and Reiter, {Robert E.} and Mack Roach and Mark Rubin and Ryan, {Charles J.} and Fred Saad and Sade, {Juan Pablo} and Oliver Sartor and Scher, {Howard I.} and Neal Shore and Eric Small and Matthew Smith and Howard Soule and Sternberg, {Cora N.} and Thomas Steuber and Hiroyoshi Suzuki and Christopher Sweeney and Sydes, {Matthew R.} and Taplin, {Mary Ellen} and Bertrand Tombal and Levent T{\"u}rkeri and {van Oort}, Inge and Almudena Zapatero and Aurelius Omlin",

note = "Funding Information: Although there was a range of opinions regarding the starting dose of chemotherapy in patients of East Asian ethnicity, 60% of panellists recommended starting chemotherapy at a reduced dose. This strategy is supported by the experience of physicians from the Asia-Pacific region and by limited studies. Although no large prospective clinical trials have compared dosing strategies (eg, a reduced dose vs a full dose with G-CSF support) in this population, the available literature suggests that antitumour activity is comparable, even if a reduced dose is used [174,175] . Publisher Copyright: {\textcopyright} 2020 The Authors",

year = "2020",

month = apr,

doi = "10.1016/j.eururo.2020.01.012",

language = "English (US)",

volume = "77",

pages = "508--547",

journal = "European Urology",

issn = "0302-2838",

publisher = "Elsevier",

number = "4",

}

TY - JOUR

T1 - Management of Patients with Advanced Prostate Cancer

T2 - Report of the Advanced Prostate Cancer Consensus Conference 2019

AU - Gillessen, Silke

AU - Attard, Gerhardt

AU - Beer, Tomasz M.

AU - Beltran, Himisha

AU - Bjartell, Anders

AU - Bossi, Alberto

AU - Briganti, Alberto

AU - Bristow, Rob G.

AU - Chi, Kim N.

AU - Clarke, Noel

AU - Davis, Ian D.

AU - de Bono, Johann

AU - Drake, Charles G.

AU - Duran, Ignacio

AU - Eeles, Ros

AU - Efstathiou, Eleni

AU - Evans, Christopher P.

AU - Fanti, Stefano

AU - Feng, Felix Y.

AU - Fizazi, Karim

AU - Frydenberg, Mark

AU - Gleave, Martin

AU - Halabi, Susan

AU - Heidenreich, Axel

AU - Heinrich, Daniel

AU - Higano, Celestia (Tia) S.

AU - Hofman, Michael S.

AU - Hussain, Maha

AU - James, Nicolas

AU - Kanesvaran, Ravindran

AU - Kantoff, Philip

AU - Khauli, Raja B.

AU - Leibowitz, Raya

AU - Logothetis, Chris

AU - Maluf, Fernando

AU - Millman, Robin

AU - Morgans, Alicia K.

AU - Morris, Michael J.

AU - Mottet, Nicolas

AU - Mrabti, Hind

AU - Murphy, Declan G.

AU - Murthy, Vedang

AU - Oh, William K.

AU - Ost, Piet

AU - O'Sullivan, Joe M.

AU - Padhani, Anwar R.

AU - Parker, Chris

AU - Poon, Darren M.C.

AU - Pritchard, Colin C.

AU - Reiter, Robert E.

AU - Roach, Mack

AU - Rubin, Mark

AU - Ryan, Charles J.

AU - Saad, Fred

AU - Sade, Juan Pablo

AU - Sartor, Oliver

AU - Scher, Howard I.

AU - Shore, Neal

AU - Small, Eric

AU - Smith, Matthew

AU - Soule, Howard

AU - Sternberg, Cora N.

AU - Steuber, Thomas

AU - Suzuki, Hiroyoshi

AU - Sweeney, Christopher

AU - Sydes, Matthew R.

AU - Taplin, Mary Ellen

AU - Tombal, Bertrand

AU - Türkeri, Levent

AU - van Oort, Inge

AU - Zapatero, Almudena

AU - Omlin, Aurelius

N1 - Funding Information: Although there was a range of opinions regarding the starting dose of chemotherapy in patients of East Asian ethnicity, 60% of panellists recommended starting chemotherapy at a reduced dose. This strategy is supported by the experience of physicians from the Asia-Pacific region and by limited studies. Although no large prospective clinical trials have compared dosing strategies (eg, a reduced dose vs a full dose with G-CSF support) in this population, the available literature suggests that antitumour activity is comparable, even if a reduced dose is used [174,175] . Publisher Copyright: © 2020 The Authors

PY - 2020/4

Y1 - 2020/4

N2 - 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.

AB - 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.

KW - Advanced prostate cancer

KW - Castration-naïve prostate cancer

KW - Castration-resistant prostate cancer

KW - Genetics

KW - High-risk localised prostate cancer

KW - Hormone-sensitive prostate cancer

KW - Imaging

KW - Oligometastatic prostate cancer

KW - Overall survival

KW - Progression-free survival

KW - Prostate cancer treatment

KW - Tumour genomic profiling

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DO - 10.1016/j.eururo.2020.01.012

M3 - Article

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SN - 0302-2838

VL - 77

SP - 508

EP - 547

JO - European Urology

JF - European Urology

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ER -

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

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

Publisher link

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