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

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Management of Patients with Advanced Prostate Cancer: Report of the Advanced Prostate Cancer Consensus Conference 2019.
European Urology ( IF 23.4 ) Pub Date : 2020-01-27 , DOI: 10.1016/j.eururo.2020.01.012
Silke Gillessen ₁ , Gerhardt Attard ₂ , Tomasz M Beer ₃ , Himisha Beltran ₄ , Anders Bjartell ₅ , Alberto Bossi ₆ , Alberto Briganti ₇ , Rob G Bristow ₈ , Kim N Chi ₉ , Noel Clarke ₁₀ , Ian D Davis ₁₁ , Johann de Bono ₁₂ , Charles G Drake ₁₃ , Ignacio Duran ₁₄ , Ros Eeles ₁₅ , Eleni Efstathiou ₁₆ , Christopher P Evans ₁₇ , Stefano Fanti ₁₈ , Felix Y Feng ₁₉ , Karim Fizazi ₂₀ , Mark Frydenberg ₂₁ , Martin Gleave ₂₂ , Susan Halabi ₂₃ , Axel Heidenreich ₂₄ , Daniel Heinrich ₂₅ , Celestia Tia S Higano ₂₆ , Michael S Hofman ₂₇ , Maha Hussain ₂₈ , Nicolas James ₂₉ , Ravindran Kanesvaran ₃₀ , Philip Kantoff ₃₁ , Raja B Khauli ₃₂ , Raya Leibowitz ₃₃ , Chris Logothetis ₃₄ , Fernando Maluf ₃₅ , Robin Millman ₃₆ , Alicia K Morgans ₂₈ , Michael J Morris ₃₇ , Nicolas Mottet ₃₈ , Hind Mrabti ₃₉ , Declan G Murphy ₄₀ , Vedang Murthy ₄₁ , William K Oh ₄₂ , Piet Ost ₄₃ , Joe M O'Sullivan ₄₄ , Anwar R Padhani ₄₅ , Chris Parker ₄₆ , Darren M C Poon ₄₇ , Colin C Pritchard ₄₈ , Robert E Reiter ₄₉ , Mack Roach ₅₀ , Mark Rubin ₅₁ , Charles J Ryan ₅₂ , Fred Saad ₅₃ , Juan Pablo Sade ₅₄ , Oliver Sartor ₅₅ , Howard I Scher ₅₆ , Neal Shore ₅₇ , Eric Small ₅₀ , Matthew Smith ₅₈ , Howard Soule ₅₉ , Cora N Sternberg ₆₀ , Thomas Steuber ₆₁ , Hiroyoshi Suzuki ₆₂ , Christopher Sweeney ₄ , Matthew R Sydes ₆₃ , Mary-Ellen Taplin ₄ , Bertrand Tombal ₆₄ , Levent Türkeri ₆₅ , Inge van Oort ₆₆ , Almudena Zapatero ₆₇ , Aurelius Omlin ₆₈

Affiliation

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.
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. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
The Institute of Cancer Research, London, UK.
Division of Medical Oncology, National Cancer Centre, Singapore.
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
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.
Oncology institute, Shamir Medical Center and Faculty of medicine, Tel-Aviv University, Israel.
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.
Beneficiência Portuguesa de São Paulo, São Paulo, SP, Brazil; Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
UK.
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
University Hospital Nord, St Etienne, France.
National Institute of Oncology, University hospital, Rabat, Morocco.
Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
Tata Memorial Centre, Mumbai, India.
Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA.
Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
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.
Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK.
Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK.
Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, The Chinese University of Hong Kong, Hong Kong.
Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
University of California Los Angeles, Los Angeles, CA, USA.
UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
Bern Center for Precision Medicine, Bern, Switzerland; Department for Biomedical Research, University of Bern, Bern, Switzerland.
Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
Centre Hospitalier de Université de Montréal, Montreal, Canada.
Instituto Alexander Fleming, Buenos Aires, Argentina.
Tulane Cancer Center, New Orleans, LA, USA.
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.
Carolina Urologic Research Center, Myrtle Beach, SC, USA.
Massachusetts General Hospital Cancer Center, Boston, MA, USA.
Prostate Cancer Foundation, Santa Monica, CA, USA.
Division of Hematology and Oncology, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Toho University Sakura Medical Center, Chiba, Japan.
MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
Cliniques Universitaires Saint Luc, Brussels, Belgium.
Department of Urology, M.A. Aydınlar Acıbadem University, Altunizade Hospital, Istanbul, Turkey.
Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Radiation Oncology, University Hospital La Princesa, Health Research Institute, Madrid, Spain.
University of Bern, Bern, Switzerland; Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.

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.

中文翻译：

晚期前列腺癌患者的治疗：2019年晚期前列腺癌共识会议的报告。

背景技术晚期前列腺癌的治疗，影像学和分子表征方面的创新已改善了结局，但管理的许多方面仍缺乏可为临床实践提供依据的高级证据。2019年高级前列腺癌共识会议（APCCC）讨论了其中一些主题，以补充基于1级证据的指南。目的展示APCCC 2019的结果。设计，设置和参加者与之前的会议相似，专家们确定了关于晚期前列腺癌管理的10个重要争议领域：局部晚期疾病，局部治疗后的生化复发，治疗原发性肿瘤在转移性环境中，转移性激素敏感性/初发前列腺癌，非转移性去势抵抗性前列腺癌，转移性去势抵抗性前列腺癌，骨骼健康和骨骼转移，组织和血液的分子特征，患者间和患者内异质性以及激素治疗及其管理的不良影响。由72位国际前列腺癌专家组成的小组制定了该计划和共识性问题。成果测量和统计分析小组对123个预先定义的问题进行公开但匿名的投票，这些问题是在会议之前经过改进的Delphi程序由投票和无投票权的小组成员共同制定的。结果与局限性小组成员根据他们的意见进行投票，而不是根据标准的文献综述或正式的荟萃分析进行投票。共识问题的答案选项得到了小组的不同程度的支持，如本文所述以及补充材料中报告的详细投票结果。结论前列腺癌专家小组的这些投票结果可以帮助临床医生和患者探索高级证据缺乏的有争议的高级前列腺管理领域。但是，应始终根据患者特定的因素（例如疾病程度和位置，先前的治疗路线，合并症和治疗偏好）以及当前和新出现的临床证据以及后勤和经济方面的限制，对诊断和治疗决策进行个体化。强烈建议晚期前列腺癌男性进行临床试验。重要的是，APCCC 2019再次确定了需要在专门设计的试验中进行评估的重要问题。患者摘要晚期前列腺癌共识会议提供了一个论坛，以讨论和辩论晚期前列腺癌患者的当前诊断和治疗选择。该会议自2015年以来已举行过三届，旨在与全球卫生保健提供者分享前列腺癌管理方面的世界专家知识。在会议结束时，一个专家小组讨论了针对预定的共识性问题并对其进行投票，这些问题针对的是晚期前列腺癌治疗的最临床相关领域。投票结果为指导临床医生与患者讨论治疗方案，作为共同和多学科决策的一部分提供了实用指南。

更新日期：2020-01-29

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