Shawn Malone1, Bobby Shayegan2, Naveen S Basappa3, Kim Chi4, Henry J Conter5, Robert J Hamilton6, Sebastien J Hotte2, Fred Saad7, Alan I So8, Laura Park-Wyllie9, Huong Hew9, Deanna McLeod10, Geoffrey Gotto11. 1. The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada. 2. Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada. 3. Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada. 4. BC Cancer Agency, Vancouver, BC, Canada. 5. William Osler Health System, University of Western Ontario, Brampton, ON, Canada. 6. Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada. 7. Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. 8. Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada. 9. Medical Affairs, Janssen Inc., Toronto, ON, Canada. 10. Kaleidoscope Strategic Inc., Toronto, ON, Canada. 11. University of Calgary, Calgary, AB, Canada.
Abstract
INTRODUCTION: Prostate cancer poses a significant lifetime risk to Canadian men. Treatment for metastatic prostatic cancer (mPCa) is an area of ongoing research with a lack of up-to-date clinical guidance. The multidisciplinary Canadian Genitourinary Research Consortium (GURC) determined that additional guidance focusing on management of mPCa was warranted. METHODS: The most up-to-date guidelines, consensus statements, and emerging phase 3 trials were identified and used to inform development of algorithms by a multidisciplinary genitourinary oncology panel outlining recommendations for the management of mPCa. RESULTS: A single pan-Canadian guideline and five national and international guidelines or consensus statements published since 2015 were identified, along with two new phase 3 trials and one additional randomized comparison. Iterative GURC discussions led to the development of two mPCa algorithms: the first addressing management of newly diagnosed metastatic castration-sensitive prostate cancer (mCSPC) patients and the second addressing treatment of patients with metastatic castration-resistant prostate cancer (mCRPC). For newly diagnosed mCSPC patients with high-volume/high-risk disease, either docetaxel or abiraterone acetate and prednisone (AAP) added to androgen-deprivation therapy (ADT) is recommended. The addition of radiotherapy to ADT is suggested for those with low-volume disease and/or AAP to ADT for low-volume or low-risk disease. For first-line mCRPC, androgen receptor-axis-targeted (ARAT) therapy is recommended for most patients, while sequencing with docetaxel, radium-223, ARAT therapy, and/or cabazitaxel is recommended for later lines of therapy. CONCLUSIONS: Two treatment algorithms were developed for the management of mPC and can be used by multidisciplinary specialist teams to guide treatment.
INTRODUCTION:Prostate cancer poses a significant lifetime risk to Canadian men. Treatment for metastatic prostatic cancer (mPCa) is an area of ongoing research with a lack of up-to-date clinical guidance. The multidisciplinary Canadian Genitourinary Research Consortium (GURC) determined that additional guidance focusing on management of mPCa was warranted. METHODS: The most up-to-date guidelines, consensus statements, and emerging phase 3 trials were identified and used to inform development of algorithms by a multidisciplinary genitourinary oncology panel outlining recommendations for the management of mPCa. RESULTS: A single pan-Canadian guideline and five national and international guidelines or consensus statements published since 2015 were identified, along with two new phase 3 trials and one additional randomized comparison. Iterative GURC discussions led to the development of two mPCa algorithms: the first addressing management of newly diagnosed metastatic castration-sensitive prostate cancer (mCSPC) patients and the second addressing treatment of patients with metastatic castration-resistant prostate cancer (mCRPC). For newly diagnosed mCSPC patients with high-volume/high-risk disease, either docetaxel or abiraterone acetate and prednisone (AAP) added to androgen-deprivation therapy (ADT) is recommended. The addition of radiotherapy to ADT is suggested for those with low-volume disease and/or AAP to ADT for low-volume or low-risk disease. For first-line mCRPC, androgen receptor-axis-targeted (ARAT) therapy is recommended for most patients, while sequencing with docetaxel, radium-223, ARAT therapy, and/or cabazitaxel is recommended for later lines of therapy. CONCLUSIONS: Two treatment algorithms were developed for the management of mPC and can be used by multidisciplinary specialist teams to guide treatment.
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