Management of Patients with Advanced Prostate Cancer. Part I: Intermediate-/High-risk and Locally Advanced Disease, Biochemical Relapse, and Side Effects of Hormonal Treatment: Report of the Advanced Prostate Cancer Consensus Conference 2022

Silke Gillessen, Alberto Bossi, Ian D. Davis, Johann de Bono, Karim Fizazi, Nicholas D. James, Nicolas Mottet, Neal Shore, Eric Small, Mathew Smith, Christopher Sweeney, Bertrand Tombal, Emmanuel S. Antonarakis, Ana M. Aparicio, Andrew J. Armstrong, Gerhardt Attard, Tomasz M. Beer, Himisha Beltran, Anders Bjartell, Pierre BlanchardAlberto Briganti, Rob G. Bristow, Muhammad Bulbul, Orazio Caffo, Daniel Castellano, Elena Castro, Heather H. Cheng, Kim N. Chi, Simon Chowdhury, Caroline S. Clarke, Noel Clarke, Gedske Daugaard, Maria De Santis, Ignacio Duran, Ros Eeles, Eleni Efstathiou, Jason Efstathiou, Onyeanunam Ngozi Ekeke, Christopher P. Evans, Stefano Fanti, Felix Y. Feng, Valerie Fonteyne, Nicola Fossati, Mark Frydenberg, Daniel George, Martin Gleave, Gwenaelle Gravis, Susan Halabi, Daniel Heinrich, Ken Herrmann, Celestia Higano, Michael S. Hofman, Lisa G. Horvath, Maha Hussain, Barbara Alicja Jereczek-Fossa, Robert Jones, Ravindran Kanesvaran, Pirkko Liisa Kellokumpu-Lehtinen, Raja B. Khauli, Laurence Klotz, Gero Kramer, Raya Leibowitz, Christopher J. Logothetis, Brandon A. Mahal, Fernando Maluf, Joaquin Mateo, David Matheson, Niven Mehra, Axel Merseburger, Alicia K. Morgans, Michael J. Morris, Hind Mrabti, Deborah Mukherji, Declan G. Murphy, Vedang Murthy, Paul L. Nguyen, William K. Oh, Piet Ost, Joe M. O'Sullivan, Anwar R. Padhani, Carmel Pezaro, Darren M.C. Poon, Colin C. Pritchard, Danny M. Rabah, Dana Rathkopf, Robert E. Reiter, Mark A. Rubin, Charles J. Ryan, Fred Saad, Juan Pablo Sade, Oliver A. Sartor, Howard I. Scher, Nima Sharifi, Iwona Skoneczna, Howard Soule, Daniel E. Spratt, Sandy Srinivas, Cora N. Sternberg, Thomas Steuber, Hiroyoshi Suzuki, Matthew R. Sydes, Mary Ellen Taplin, Derya Tilki, Levent Türkeri, Fabio Turco, Hiroji Uemura, Hirotsugu Uemura, Yüksel Ürün, Claire L. Vale, Inge van Oort, Neha Vapiwala, Jochen Walz, Kosj Yamoah, Dingwei Ye, Evan Y. Yu, Almudena Zapatero, Thomas Zilli, Aurelius Omlin

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51 Citations (Scopus)


Background: Innovations in imaging and molecular characterisation and the evolution of new therapies have improved outcomes in advanced prostate cancer. Nonetheless, we continue to lack high-level evidence on a variety of clinical topics that greatly impact daily practice. To supplement evidence-based guidelines, the 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) surveyed experts about key dilemmas in clinical management. Objective: To present consensus voting results for select questions from APCCC 2022. Design, setting, and participants: Before the conference, a panel of 117 international prostate cancer experts used a modified Delphi process to develop 198 multiple-choice consensus questions on (1) intermediate- and high-risk and locally advanced prostate cancer, (2) biochemical recurrence after local treatment, (3) side effects from hormonal therapies, (4) metastatic hormone-sensitive prostate cancer, (5) nonmetastatic castration-resistant prostate cancer, (6) metastatic castration-resistant prostate cancer, and (7) oligometastatic and oligoprogressive prostate cancer. Before the conference, these questions were administered via a web-based survey to the 105 physician panel members (“panellists”) who directly engage in prostate cancer treatment decision-making. Herein, we present results for the 82 questions on topics 1–3. Outcome measurements and statistical analysis: Consensus was defined as ≥75% agreement, with strong consensus defined as ≥90% agreement. Results and limitations: The voting results reveal varying degrees of consensus, as is discussed in this article and shown in the detailed results in the Supplementary material. The findings reflect the opinions of an international panel of experts and did not incorporate a formal literature review and meta-analysis. Conclusions: These voting results by a panel of international experts in advanced prostate cancer can help physicians and patients navigate controversial areas of clinical management for which high-level evidence is scant or conflicting. The findings can also help funders and policymakers prioritise areas for future research. Diagnostic and treatment decisions should always be individualised based on patient and cancer characteristics (disease extent and location, treatment history, comorbidities, and patient preferences) and should incorporate current and emerging clinical evidence, therapeutic guidelines, and logistic and economic factors. Enrolment in clinical trials is always strongly encouraged. Importantly, APCCC 2022 once again identified important gaps (areas of nonconsensus) that merit evaluation in specifically designed trials. Patient summary: The Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with health care providers and patients worldwide. At each APCCC, a panel of physician experts vote in response to multiple-choice questions about their clinical opinions and approaches to managing advanced prostate cancer. This report presents voting results for the subset of questions pertaining to intermediate- and high-risk and locally advanced prostate cancer, biochemical relapse after definitive treatment, advanced (next-generation) imaging, and management of side effects caused by hormonal therapies. The results provide a practical guide to help clinicians and patients discuss treatment options as part of shared multidisciplinary decision-making. The findings may be especially useful when there is little or no high-level evidence to guide treatment decisions.

Original languageEnglish
Pages (from-to)267-293
Number of pages27
JournalEuropean Urology
Issue number3
Publication statusPublished - Mar 2023


  • Adjuvant therapy
  • Biochemical recurrence
  • Hormonal treatment
  • Locally advanced prostate cancer
  • Next-generation imaging
  • Prostate cancer
  • Prostate-specific membrane antigen positron emission tomography imaging
  • Salvage radiation therapy
  • Salvage therapy
  • Side effects

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