Controversial issues in the management of patients with advanced prostate cancer: Results from a Canadian consensus forum

  • Fred Saad
  • Christina Canil
  • Antonio Finelli
  • Sebastien J. Hotte
  • Shawn Malone
  • Bobby Shayegan
  • Alan I. So
  • Lorne Aaron
  • Naveen S. Basappa
  • Henry J. Conter
  • Brita Danielson
  • Geoffrey Gotto
  • Robert J. Hamilton
  • Jason P. Izard
  • Anil Kapoor
  • Michael Kolinsky
  • Aly-Khan A. Lalani
  • Jean-Baptiste Lattouf
  • Christopher Morash
  • Scott C. Morgan
  • Tamim Niazi
  • Krista L. Noonan
  • Michael Ong
  • Ricardo A. Rendon
  • Sandeep Sehdev
  • Huong Hew
  • Laura Park-Wyllie Janssen Inc
  • Kim N. Chi`
Keywords: Advanced Prostate Cancer, Consensus Statement, Treatment, Management

Abstract

Introduction: The management of advanced prostate cancer (PCa) continues to evolve with the emergence of new diagnostic and therapeutic strategies. As a result, there are multiple areas in this landscape with a lack of high-level evidence to guide practice. Consensus initiatives are an approach to establishing practice guidance in areas where evidence is unclear. We conducted a Canadian-based consensus forum to address key controversial areas in the management of advanced PCa.

Methods: As part of a modified Delphi process, a core scientific group of PCa physicians (n=8) identified controversial areas for discussion and developed an initial set of questions, which were then reviewed and finalized with a larger group of 29 multidisciplinary PCa specialists. The main areas of focus were non-metastatic castration-resistant prostate cancer (nmCRPC), metastatic castration-sensitive prostate cancer (mCSPC), metastatic castration-resistant prostate cancer (mCRPC), oligometastatic prostate cancer, genetic testing in prostate cancer, and imaging in advanced prostate cancer. The predetermined threshold for consensus was set at 74% (agreement from 20 of 27 participating physicians).

Results: Consensus participants included uro-oncologists (n=13), medical oncologists (n=10), and radiation oncologists (n=4). Of the 64 questions, consensus was reached in 30 questions (n=5 unanimously). Consensus was more common for questions related to biochemical recurrence, sequencing of therapies, and mCRPC.

Conclusions: A Canadian consensus forum in PCa identified areas of agreement in nearly 50% of questions discussed. Areas of variability may represent opportunities for further research, education, and sharing of best practices. These findings reinforce the value of multidisciplinary consensus initiatives to optimize patient care.

Published
2019-11-05
How to Cite
Saad, F., Canil, C., Finelli, A., Hotte, S. J., Malone, S., Shayegan, B., So, A. I., Aaron, L., Basappa, N. S., Conter, H. J., Danielson, B., Gotto, G., Hamilton, R. J., Izard, J. P., Kapoor, A., Kolinsky, M., Lalani, A.-K. A., Lattouf, J.-B., Morash, C., Morgan, S. C., Niazi, T., Noonan, K. L., Ong, M., Rendon, R. A., Sehdev, S., Hew, H., Park-Wyllie, L., & Chi`K. N. (2019). Controversial issues in the management of patients with advanced prostate cancer: Results from a Canadian consensus forum. Canadian Urological Association Journal, 14(4), E137-49. https://doi.org/10.5489/cuaj.6082