In recent years, significant progress has been made in the field of advanced prostate cancer, with innovations in imaging and molecular characterization leading to the development of new and more effective therapies. These advancements have undoubtedly improved outcomes for patients facing this challenging condition.
However, despite these strides, there remain critical areas where high-level evidence is lacking, creating a need for expert consensus to guide clinical practice. To address this gap, the 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) convened a panel of international experts to survey their opinions on key dilemmas in the management of advanced prostate cancer.Â
The APCCC serves as a vital platform for the discussion and debate of current diagnostic and treatment options for patients with advanced prostate cancer. This global event aims to harness the collective knowledge and expertise of international prostate cancer specialists and make this information accessible to healthcare providers and patients worldwide.
At each APCCC, a panel of physician experts responds to multiple-choice questions, offering their clinical opinions and approaches to managing advanced prostate cancer. These voting results, presented in this report, focus on a range of critical topics, including intermediate- and high-risk and locally advanced prostate cancer, biochemical relapse following definitive treatment, advanced imaging techniques, and the management of side effects associated with hormonal therapies.
The aim is to provide practical guidance to aid clinicians and patients in discussing treatment options and to facilitate shared decision-making in multidisciplinary care settings. This guidance is especially valuable when there is limited high-level evidence available to inform treatment decisions. Before the conference took place, a panel of 117 international prostate cancer experts engaged in a modified Delphi process to develop a comprehensive set of 198 multiple-choice consensus questions.Â
These questions covered seven key areas, including different stages of the disease and various treatment scenarios. The panel members, who are actively involved in prostate cancer treatment decision-making, then participated in a web-based survey to provide their responses to these questions.
In this report, we focus on the findings related to topics that include intermediate- and high-risk prostate cancer, locally advanced disease, and the management of biochemical recurrence after local treatment. The level of consensus among the panel members was clearly defined, with consensus set at 75% agreement and strong consensus requiring 90% agreement.
The results of the voting process revealed varying degrees of consensus among the experts, and these findings are elaborated upon in the supplementary material. It’s important to note that these results represent the collective opinions of a diverse group of international experts and were not derived from a formal literature review or meta-analysis.Â
It’s essential to emphasize that diagnostic and treatment decisions should always be individualized, considering the unique characteristics of each patient and their specific cancer profile. Factors such as the extent and location of the disease, treatment history, comorbidities, and patient preferences should all be considered.
Furthermore, these decisions should incorporate the most up-to-date clinical evidence, therapeutic guidelines, and practical and economic considerations. Enrolling patients in clinical trials is a practice strongly encouraged, as it contributes to the advancement of medical knowledge and the development of improved therapies. Importantly, APCCC 2022 identified several areas of non-consensus, highlighting the need for future research designed to address these knowledge gaps.Â
Reference Â
Gillessen S, Bossi A, et al., Management of Patients with Advanced Prostate Cancer Part I: Intermediate-/High-risk and Locally Advanced Disease, Biochemical Relapse, and Side Effects of Hormonal Treatment: Report of the Advanced Prostate Cancer Consensus Conference 2022. Eur Urol. 2023 Mar;83(3):267-293. doi: 10.1016/j.eururo.2022.11.002. Â
