Addressing controversial areas in the management of advanced prostate cancer in Canada

Areas of consensus and controversy from the third Canadian consensus forum

Authors

  • Fred Saad Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC, Canada
  • Sebastien J. Hotte Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
  • Krista Noonan BC Cancer Agency, University of British Columbia, Surrey, BC, Canada
  • Shawn Malone The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
  • Christopher Morash Jewish General Hospital, McGill University, Montreal, QC, Canada
  • Tamim Niazi Jewish General Hospital, McGill University, Montreal, QC, Canada
  • Ricardo A. Rendon Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
  • Bobby Shayegan St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
  • Naveen S. Basappa Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
  • Ilias Cagiannos The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
  • Brita Danielson Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
  • Guila Delouya Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC, Canada
  • Ricardo Fernandes London Health Science Centre, Western University, Toronto, ON, Canada
  • Cristiano Ferrario Jewish General Hospital, McGill University, Montreal, QC, Canada
  • Antonio Finelli Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
  • Geoffrey T. Gotto Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada
  • Robert J. Hamilton Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
  • Jason P. Izard Kingston Health Sciences Centre, Queen’s University, Kingston, ON
  • Anil Kapoor St. Joseph’s Healthcare, McMaster University, Hamilton, ON, Canada
  • Aly-Khan Lalani Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
  • Luke T. Lavallée The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
  • Michael Ong The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
  • Frédéric Pouliot Quebec City University Hospital Center & Centre de Recherche of Quebec City University Hospital Center, University of Laval, QC, Canada
  • Alan I. So Prostate Centre at Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
  • Steven Yip Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
  • Kim N. Chi 1BC Cancer Agency, University of British Columbia, Vancouver, BC, Canada

DOI:

https://doi.org/10.5489/cuaj.8537

Keywords:

Advanced prostate cancer, consensus statement, treatment, management

Abstract

INTRODUCTION: The management of prostate cancer (PCa) is rapidly evolving. Treatment and diagnostic options grow annually, however, high-level evidence for the use of new therapeutics and diagnostics is lacking. In November 2022, the Genitourinary Research Consortium held its 3rd Canadian Consensus Forum (CCF3) to provide guidance on key controversial areas for management of PCa.

METHODS: A steering committee of eight multidisciplinary physicians identified topics for discussion and adapted questions from the Advanced Prostate Cancer Consensus Conference 2022 for CCF3. Questions focused on management of metastatic castration-sensitive prostate cancer (mCSPC); use of novel imaging, germline testing, and genomic profiling; and areas of non-consensus from CCF2. Fifty-eight questions were voted on during a live forum, with threshold for “consensus agreement” set at 75%.

RESULTS: The voting panel consisted of 26 physicians: 13 urologists/uro-oncologists, nine medical oncologists, and four radiation oncologists. Consensus was reached for 32 of 58 questions (one ad-hoc). Consensus was seen in the use of local treatment, to not use metastasis-directed therapy for low-volume mCSPC, and to use triplet therapy for synchronous high-volume mCSPC (low prostate-specific antigen). Consensus was also reached on sufficiency of conventional imaging to manage disease, use of germline testing and genomic profiling for metastatic disease, and poly (ADP-ribose) polymerase (PARP) inhibitors for BRCA-positive prostate cancer.

CONCLUSIONS: CCF3 identified consensus agreement and provides guidance on >30 practice scenarios related to management of PCa and nine areas of controversy, which represent opportunities for research and education to improve patient care. Consensus initiatives provide valuable guidance on areas of controversy as clinicians await high-level evidence.

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Published

2023-12-21

How to Cite

Saad, F., Hotte, S. J., Noonan, K., Malone, S. ., Morash, C., Niazi, T., Rendon, R. A., Shayegan, B., Basappa, N. S., Cagiannos, I., Danielson, B., Delouya, G., Fernandes, R., Ferrario, C., Finelli, A., Gotto, G. T., Hamilton, R. J., Izard, J. P., Kapoor, A., Lalani, A.-K., Lavallée, L. T., Ong, M., Pouliot, F., So, A. I., Yip, S., & Chi, K. N. (2023). Addressing controversial areas in the management of advanced prostate cancer in Canada : Areas of consensus and controversy from the third Canadian consensus forum . Canadian Urological Association Journal, 18(4), E126–37. https://doi.org/10.5489/cuaj.8537

Issue

Vol. 18 No. 4 (2024): CUAJ April

Section

Special Feature

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