Optimal management of metastatic castration-resistant prostate cancer: highlights from a European Expert Consensus Panel.
The exponential growth of novel therapies for the treatment of metastatic castration-resistant prostate cancer (mCRPC) over the last decade has created an acute need for education and guidance of clinicians regarding optimal strategies for patient management. A multidisciplinary panel of 21 European experts in mCRPC assembled for comprehensive discussion and consensus development, seeking to move the field forward and provide guidance and perspectives on optimal selection and sequencing of therapeutic agents and monitoring of response to treatment and disease progression. A total of 110 clinically-relevant questions were addressed and a modified Delphi method was utilised to obtain a consensus. The panel reached a consensus on several important issues, providing recommendations on appropriate phase III clinical trial end-points and optimal strategies for imaging and monitoring of bone metastases. Guidance regarding selection and sequencing of therapy in patients with newly diagnosed or progressive mCRPC is emphasised, including the use of novel bone-targeted agents, chemotherapy, androgen receptor pathway-targeted agents and immunotherapy. The impact of drug resistance and prostate-specific antigen flare on treatment decisions was also addressed. Ultimately, individualised therapy for patients with mCRPC is dependent on continued refinement of clinical decision-making based on patient and disease characteristics. This consensus statement offers clinicians expert guidance on the implementation of recent advances to improve patient outcome, focusing on the future of prostate cancer care.
Irish Cancer Society and University College, Dublin, Ireland. Electronic address: jfitzpatrick@irishcancer.ie.
John M
JM
Fitzpatrick
University Hospital del Mar, Barcelona, Spain.
Joaquim
J
Bellmunt
Institut Gustave Roussy, University of Paris Sud, Villejuif, France.
Karim
K
Fizazi
University Hospital Aachen, Aachen, Germany.
Axel
A
Heidenreich
San Camillo and Forlanini Hospital, Rome, Italy.
Cora N
CN
Sternberg
Centre du Cancer et Institut de Recherche Expérimental et Clinique (IREC), Cliniques Universitaires Saint Luc, Brussels, Belgium.
Bertrand
B
Tombal
Hospital Clinic de Barcelona, Barcelona, Spain.
Antonio
A
Alcaraz
University Hospitals Bristol, Bristol, United Kingdom.
Amit
A
Bahl
Ospedale San Donato, Istituto Toscano Tumori (ITT), Arezzo, Italy.
Sergio
S
Bracarda
University Federico II, Napoli, Italy.
Giuseppe
G
Di Lorenzo
University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States.
Eleni
E
Efstathiou
St. James's Hospital and Trinity College, Dublin, Ireland.
Stephen P
SP
Finn
Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
Sophie
S
Fosså
Kantonsspital St. Gallen, St. Gallen, Switzerland.
Silke
S
Gillessen
Tampere University Hospital, Tampere, Finland.
Pirkko-Liisa
PL
Kellokumpu-Lehtinen
Centre du Cancer et Institut de Recherche Expérimental et Clinique (IREC), Cliniques Universitaires Saint Luc, Brussels, Belgium.
Frédéric E
FE
Lecouvet
Georges Pompidou European Hospital, Paris, France.
Stephane
S
Oudard
Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
Theo M
TM
de Reijke
Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.
Craig N
CN
Robson
Ludwig Boltzmann Institute for Applied Cancer Research, Kaiser Franz Josef-Spital, Vienna, Austria.
Maria
M
De Santis
Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
Bostjan
B
Seruga
Erasmus University Medical Center, Rotterdam, The Netherlands.
Ronald
R
de Wit
D059002:Androgen Receptor Antagonists / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy / Q000379:methods; D003952:Diagnostic Imaging / Q000379:methods; D018450:Disease Progression; D019008:Drug Resistance, Neoplasm; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008297:Male; D064129:Prostatic Neoplasms, Castration-Resistant / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome
D059002:Androgen Receptor Antagonists; D050071:Bone Density Conservation Agents
Abiraterone; Cabazitaxel; Circulating tumour cells; Consensus; Denosumab; Docetaxel; Enzalutamide; Metastatic castration-resistant prostate cancer; Radium 223 dichloride; Sipuleucel-T