Silke Gillessen1, Gerhardt Attard2, Tomasz M Beer3, Himisha Beltran4, Alberto Bossi5, Rob Bristow6, Brett Carver7, Daniel Castellano8, Byung Ha Chung9, Noel Clarke10, Gedske Daugaard11, Ian D Davis12, Johann de Bono2, Rodolfo Borges Dos Reis13, Charles G Drake14, Ros Eeles15, Eleni Efstathiou16, Christopher P Evans17, Stefano Fanti18, Felix Feng19, Karim Fizazi20, Mark Frydenberg21, Martin Gleave22, Susan Halabi23, Axel Heidenreich24, Celestia S Higano25, Nicolas James26, Philip Kantoff27, Pirkko-Liisa Kellokumpu-Lehtinen28, Raja B Khauli29, Gero Kramer30, Chris Logothetis31, Fernando Maluf32, Alicia K Morgans33, Michael J Morris34, Nicolas Mottet35, Vedang Murthy36, William Oh37, Piet Ost38, Anwar R Padhani39, Chris Parker40, Colin C Pritchard41, Mack Roach19, Mark A Rubin42, Charles Ryan43, Fred Saad44, Oliver Sartor45, Howard Scher46, Avishay Sella47, Neal Shore48, Matthew Smith49, Howard Soule50, Cora N Sternberg51, Hiroyoshi Suzuki52, Christopher Sweeney53, Matthew R Sydes54, Ian Tannock55, Bertrand Tombal56, Riccardo Valdagni57, Thomas Wiegel58, Aurelius Omlin59. 1. Department of Medical Oncology, Cantonal Hospital St. Gallen and University of Berne, Switzerland. Electronic address: silke.gillessen@kssg.ch. 2. Department of Medical Oncology, The Institute of Cancer Research/Royal Marsden, London, UK. 3. Oregon Health & Science University Knight Cancer Institute, OR, USA. 4. Department of Medical Oncology, Weill Cornell Medicine, New York, NY, USA. 5. Department of Radiation Oncology, Genito Urinary Oncology, Prostate Brachytherapy Unit, Goustave Roussy, Paris, France. 6. Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, USA. 7. Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers, New York, NY, USA. 8. Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain. 9. Department of Urology, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea. 10. Department of Urology, The Christie and Salford Royal Hospitals, Manchester, UK. 11. Department of Medical Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. 12. Monash University and Eastern Health, Eastern Health Clinical School, Box Hill, Australia. 13. Department of Urology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil. 14. Department of Medical Oncology, Division of Haematology/Oncology, Columbia University Medical Center, New York, NY, USA. 15. Department of Clinical Oncology and Genetics, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK. 16. Department of Medical Oncology, University of Texas MD Anderson Cancer Center, TX, USA. 17. Department of Urology, University of California, Davis School of Medicine, CA, USA. 18. Department of Nuclear Medicine, Policlinico S. Orsola, Università di Bologna, Italy. 19. Department of Radiation Oncology, University of California, San Francisco, CA, USA. 20. Department of Medical Oncology, Gustave Roussy, University of Paris Sud, Paris, France. 21. Department of Surgery, Department of Anatomy and Developmental Biology, Faculty of Medicine, Nursing and Health Sciences, Monash University. 22. Department of Urology, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada. 23. Department of Clinical trials and Statistics, Duke University, Durham, NC, USA. 24. Department of Urology, University Hospital Köln, Köln, Germany. 25. Department of Medicine, Division of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, WA, USA. 26. Department of Clinical Oncology, Clinical Oncology Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK. 27. Department of Medical Oncology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA. 28. Department of Clinical Oncology, Tampere University Hospital, Faculty of Medicine and Life Sciences, University of Tampere, Finland. 29. Department of Urology, American University of Beirut Medical Center, Beirut, Lebanon. 30. Department of Urology, Medical University of Vienna, Vienna, Austria. 31. Department of Genitourinary Medical Oncology, MD Anderson Cancer Centre, Houston, TX, USA. 32. Department of Medical Oncology Hospital Israelita Albert Einstein and Department of Medical Oncology Beneficência Portuguesa de São Paulo. 33. Department of Medical Oncology and Epidemiology, Vanderbilt University Medical Center, Division of Hematology/Oncology, Nashville, TN, USA. 34. Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 35. Department of Urology, University Hospital Nord St. Etienne, St. Etienne, France. 36. Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India. 37. Department of Medical Oncology, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA. 38. Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium. 39. Department of Radiology, Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK. 40. Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, Sutton, UK. 41. Department of Pathology, University of Washington, WA, USA. 42. Department of Pathology, University of Bern and the Inselspital, Bern (CH). 43. Department of Medical Oncology, Clinical Medicine and Urology at the Helen Diller Family Comprehensive Cancer Center at the University of, California, San Francisco, CA, USA. 44. Department of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. 45. Department of Medical Oncology, Tulane Cancer Center, New Orleans, LA, USA. 46. Department of Medical Oncology, Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA. 47. Department of Medical Oncology, Department of Oncology, Assaf Harofeh Medical Centre, Tel-Aviv University, Sackler School of Medicine, Zerifin, Israel. 48. Department of Urology, Carolina Urologic Research Center, Myrtle Beach, SC, USA. 49. Department of Medical Oncology, Massachusetts General Hospital Cancer Centre, Boston, MA, USA. 50. Prostate Cancer Foundation, Santa Monica, CA, USA. 51. Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy. 52. Department of Urology, Toho University Sakura Medical Center, Japan. 53. Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 54. MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK. 55. Department of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada. 56. Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium. 57. Department of Oncology and Haemato-oncology, Università degli Studi di Milano. Radiation Oncology 1, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 58. Department of Radiation Oncology, Klinik für Strahlentherapie und Radioonkologie des Universitätsklinikum Ulm, Albert-Einstein-Allee, Ulm, Germany. 59. Department of Medical Oncology, Cantonal Hospital St. Gallen and University of Berne, Switzerland.
Abstract
BACKGROUND: In advanced prostate cancer (APC), successful drug development as well as advances in imaging and molecular characterisation have resulted in multiple areas where there is lack of evidence or low level of evidence. The Advanced Prostate Cancer Consensus Conference (APCCC) 2017 addressed some of these topics. OBJECTIVE: To present the report of APCCC 2017. DESIGN, SETTING, AND PARTICIPANTS: Ten important areas of controversy in APC management were identified: high-risk localised and locally advanced prostate cancer; "oligometastatic" prostate cancer; castration-naïve and castration-resistant prostate cancer; the role of imaging in APC; osteoclast-targeted therapy; molecular characterisation of blood and tissue; genetic counselling/testing; side effects of systemic treatment(s); global access to prostate cancer drugs. A panel of 60 international prostate cancer experts developed the program and the consensus questions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The panel voted publicly but anonymously on 150 predefined questions, which have been developed following a modified Delphi process. RESULTS AND LIMITATIONS: Voting is based on panellist opinion, and thus is not based on a standard literature review or meta-analysis. The outcomes of the voting had varying degrees of support, as reflected in the wording of this article, as well as in the detailed voting results recorded in Supplementary data. CONCLUSIONS: The presented expert voting results can be used for support in areas of management of men with APC where there is no high-level evidence, but individualised treatment decisions should as always be based on all of the data available, including disease extent and location, prior therapies regardless of type, host factors including comorbidities, as well as patient preferences, current and emerging evidence, and logistical and economic constraints. Inclusion of men with APC in clinical trials should be strongly encouraged. Importantly, APCCC 2017 again identified important areas in need of trials specifically designed to address them. PATIENT SUMMARY: The second Advanced Prostate Cancer Consensus Conference APCCC 2017 did provide a forum for discussion and debates on current treatment options for men with advanced prostate cancer. The aim of the conference is to bring the expertise of world experts to care givers around the world who see less patients with prostate cancer. The conference concluded with a discussion and voting of the expert panel on predefined consensus questions, targeting areas of primary clinical relevance. The results of these expert opinion votes are embedded in the clinical context of current treatment of men with advanced prostate cancer and provide a practical guide to clinicians to assist in the discussions with men with prostate cancer as part of a shared and multidisciplinary decision-making process.
BACKGROUND: In advanced prostate cancer (APC), successful drug development as well as advances in imaging and molecular characterisation have resulted in multiple areas where there is lack of evidence or low level of evidence. The Advanced Prostate Cancer Consensus Conference (APCCC) 2017 addressed some of these topics. OBJECTIVE: To present the report of APCCC 2017. DESIGN, SETTING, AND PARTICIPANTS: Ten important areas of controversy in APC management were identified: high-risk localised and locally advanced prostate cancer; "oligometastatic" prostate cancer; castration-naïve and castration-resistant prostate cancer; the role of imaging in APC; osteoclast-targeted therapy; molecular characterisation of blood and tissue; genetic counselling/testing; side effects of systemic treatment(s); global access to prostate cancer drugs. A panel of 60 international prostate cancer experts developed the program and the consensus questions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The panel voted publicly but anonymously on 150 predefined questions, which have been developed following a modified Delphi process. RESULTS AND LIMITATIONS: Voting is based on panellist opinion, and thus is not based on a standard literature review or meta-analysis. The outcomes of the voting had varying degrees of support, as reflected in the wording of this article, as well as in the detailed voting results recorded in Supplementary data. CONCLUSIONS: The presented expert voting results can be used for support in areas of management of men with APC where there is no high-level evidence, but individualised treatment decisions should as always be based on all of the data available, including disease extent and location, prior therapies regardless of type, host factors including comorbidities, as well as patient preferences, current and emerging evidence, and logistical and economic constraints. Inclusion of men with APC in clinical trials should be strongly encouraged. Importantly, APCCC 2017 again identified important areas in need of trials specifically designed to address them. PATIENT SUMMARY: The second Advanced Prostate Cancer Consensus Conference APCCC 2017 did provide a forum for discussion and debates on current treatment options for men with advanced prostate cancer. The aim of the conference is to bring the expertise of world experts to care givers around the world who see less patients with prostate cancer. The conference concluded with a discussion and voting of the expert panel on predefined consensus questions, targeting areas of primary clinical relevance. The results of these expert opinion votes are embedded in the clinical context of current treatment of men with advanced prostate cancer and provide a practical guide to clinicians to assist in the discussions with men with prostate cancer as part of a shared and multidisciplinary decision-making process.
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