TY - JOUR AU - Malone, Shawn AU - Shayegan, Bobby AU - Basappa, Naveen S. AU - Chi, Kim AU - Conter, Henry J. AU - Hamilton, Robert J. AU - Hotte, Sebastien J. AU - Saad, Fred AU - So, Alan I. AU - Park-Wyllie, Laura AU - Hew, Huong AU - McLeod, Deanna AU - Gotto, Geoffrey PY - 2019/04/26 Y2 - 2024/03/28 TI - Management algorithms for metastatic prostate cancer JF - Canadian Urological Association Journal JA - CUAJ VL - 14 IS - 2 SE - Review DO - 10.5489/cuaj.5840 UR - https://cuaj.ca/index.php/journal/article/view/5840 SP - 50-60 AB - <p><strong>Introduction:</strong> 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.</p><p><strong>Methods:</strong> 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.</p><p><strong>Results:</strong> 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.</p><p><strong>Conclusions:</strong> Two treatment algorithms were developed for the management of mPCa and can be used by multidisciplinary specialist teams to guide treatment.</p> ER -