Management algorithms for metastatic prostate cancer

  • Shawn Malone The Ottawa Hospital, University of Ottawa
  • Bobby Shayegan Juravinski Cancer Centre, McMaster University
  • Naveen S. Basappa Cross Cancer Institute, University of Alberta
  • Kim Chi BC Cancer Agency
  • Henry J. Conter William Osler Health System, University of Western Ontario
  • Robert J. Hamilton Princess Margaret Cancer Centre, University of Toronto
  • Sebastien J. Hotte Juravinski Cancer Centre, McMaster University
  • Fred Saad Centre Hospitalier de l’Université de Montréal, University of Montreal
  • Alan So Vancouver Prostate Centre, University of British Columbia
  • Laura Park-Wyllie Janssen Inc.
  • Huong Hew Janssen Inc.
  • Deanna McLeod Kaleidoscope Strategic Inc.
  • Geoffrey Gotto Southern Alberta Institute Of Urology, Calgary, AB
Keywords: prostate cancer; metastatic; castration-sensitive; castration-resistant; treatment

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.

Published
2019-01-18
How to Cite
Malone, S., Shayegan, B., Basappa, N. S., Chi, K., Conter, H. J., Hamilton, R. J., Hotte, S. J., Saad, F., So, A., Park-Wyllie, L., Hew, H., McLeod, D., & Gotto, G. (2019). Management algorithms for metastatic prostate cancer. Canadian Urological Association Journal, 14(2). https://doi.org/10.5489/cuaj.5840