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Highlights from the 2022 Advanced Prostate Cancer Consensus Conference (APCCC)
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| mHSPC: Do We Need More Granularity? Systemic Treatment Options for the Different Subgroups
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| Mary-Ellen Taplin, MD
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| Mary Ellen Taplin discussed systemic treatment options for different subgroups among patients with mHSPC. Dr. Taplin notes that the actual number of M0, M1 versus de novo mHSPC patients is likely a function of (i) PSA screening and treatment of localized disease (ie. higher in the USA than in the UK), and (ii) treatment with ADT for rising PSA after local therapy leading to M0 CRPC. Furthermore, many men with M0 to M1 HSPC may get SBRT and not get referred for trials and put on intermittent ADT.
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| Update on Movember and the IRONMAN Project |
| Jane Fisher, Ph.D., and Daniel George, MD |
| The 2022 Advanced Prostate Cancer Consensus Conference (APCCC) Hybrid Meeting included the Movember session, with a Movember update from Dr. Jane Fisher, and a presentation by Dr. Dan George discussing updates from the IRONMAN Project. |
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Management of Non-Metastatic CRPC
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| M0 CRPC: Overview of Treatment Options
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| Eleni Efstathiou, MD, Ph.D.
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| Eleni Efstathiou discussed an overview of treatment options in this disease space. Dr. Efstathiou notes that progression to CRPC is essentially the admission of failure to cure, thus it is important to optimize treatment prior to nmCRPC, particularly when there is an opportunity to cure in the localized setting and an opportunity to salvage in the biochemical recurrence setting.
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| Advantages of Using Novel Imaging in nmCRPC |
| Michael Morris, MD |
| Michael Morris discussed the advantages of using novel imaging in the management of non-metastatic castrate-resistant prostate cancer. The state of nmCRPC is (re)defined by imaging, specifically by the inadequacy of standard imaging. For accurate representation of disease extent and distribution, you simply cannot use conventional imaging for this disease state. Molecular imaging will drive new nomenclature, new treatment paradigms, new trial designs, and new biologic and genomic correlates. |
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Importance of Lifestyle and Prevention of Complications in Advanced Prostate Cancer
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| How to Take Care of the Bones?
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| Oliver Sartor, MD
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| In this presentation, Oliver Sartor discussed how we should take care of our patient’s bones in regards to the importance of lifestyle and prevention of complications in advanced prostate cancer. Bone health agents continue to be underutilized. Denosumab cessation is associated with rebound risk. Overuse of skeletal-related event agents persists in castration-sensitive prostate cancer and dosing intervals are not fully resolved.
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| How to Take Care of the Heart? |
| Fred Saad, MD, FRCS |
| Fred Saad gave a presentation discussing how we should take care of our patient’s heart. Dr. Saad started his presentation by emphasizing that cardiovascular mortality is the leading cause of death in patients with prostate cancer. ADT associated with cardiovascular events and cardiovascular death in observational studies are not consistently reproducible in randomized clinical trials. We should institute prevention strategies in all of our patients, including smoking cessation, exercise, and perhaps statins, aspirin, and metformin. |
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| How to Take Care of Muscle Strength?
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| Heather Chang, MD, Ph.D.
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| Heather Cheng discussed how we should take care of our patient’s muscle strength. Dr. Cheng started her presentation by highlighting that across the prostate cancer disease spectrum, ADT is utilized as a backbone for a significant portion of treatment. |
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| How to Take Care of Brain and Mood? |
| Charles Ryan, MD |
| Charles Ryan discussed how we should take care of our patient’s brain and mood. Dr. Ryan started by defining the brain as an organ with a plethora of androgen receptors, which may be impacted by the treatments we prescribe our patients, as well as defining ‘mood’ as a mental health impact of being an advanced prostate cancer patient. |
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Management of Metastatic CRPC
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| Lutetium-PSMA Therapy |
| Matthew Smith, MD, Ph.D. |
| Matthew Smith discussed the role of prostate specific membrane antigen (PSMA)-lutetium radionuclide therapy, including considerations regarding monotherapy, combination therapy, and patient selection. Dr. Smith emphasized that 177Lu-PSMA-617 is now a treatment option for patients with heavily pretreated mCRPC with evidence of significantly improved survival. Baseline PSMA avidity appears to be predictive of the response to treatment and may help guide patient selection. Numerous outstanding questions will be addressed in ongoing and planned studies. |
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| Is There Still a Role for Radium-223? |
| Neal D. Shore, MD, FACS |
| Neal Shore discussed the role of radium-223 in the modern treatment armamentarium. Setting the stage for this, he first discussed the evolving landscape of treatment options in mCRPC. Dr. Shore emphasized that mCRPC treatment decisions depend on prior treatments received. Radium-223 is a novel mechanism of action for treatment, which will not have previously been exhausted. There are many ongoing trials in both the mCRPC and metastatic castration sensitive space that will help better define the role of radium-223. |
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| Optimal Treatment Sequencing in mCRPC
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| Maha Hussain, MD, FACP FASCO
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| In the session of the 2022 Advanced Prostate Cancer Consensus Conference focusing on the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC), Dr. Maha Hussain discussed the optimal treatment sequencing in mCRPC. Dr. Hussein emphasized that there has been tremendous progress in the management of patients with nmCRPC, mCSPC, and mCRPC. This has resulted in complex considerations regarding treatment sequencing. While moving effective therapy to earlier disease states has a better “return on investment”, we need to better understand how this affects response to in-class agents and different agents in mCRPC.
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| Debate: PARP Inhibitors for All mCRPC Patients
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| Noel Clarke, MBBS, FRCS, ChM
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| In the session of the 2022 Advanced Prostate Cancer Consensus Conference focusing on the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC), Dr. Noel Clarke and Dr. Johann de Bono debated the role of PARP inhibitors for mCRPC patients. Dr. Clarke began by discussing a role for PARP inhibitors for all patients with mCRPC.
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| Debate: PARP Inhibitors Only in Selected mCRPC Patients
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| Johann de Bono, MD, MSc, PhD, FRCP, FMedSci
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| In the session of the 2022 Advanced Prostate Cancer Consensus Conference focusing on the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC), Dr. Noel Clarke and Dr. Johann de Bono debated the role of PARP inhibitors for mCRPC patients. Dr. de Bono presented the case for a selected, judicious use of PARP inhibitors in this setting.
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| Update on Immune Checkpoint Inhibitors
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| Emmanuel Antonarakis, MD, MBBCh |
| Emmanuel Antonarakis provided an update on the role of immune checkpoint inhibitors in this disease space. He emphasized that there are no approved immune checkpoint inhibitors for molecularly unselected patients with prostate cancer, though pembrolizumab is approved with a tumor site-agnostic indication for patients with MMR deficiency. However, there are multiple ongoing phase III trials of immune checkpoint inhibitor based combination therapies in this disease space. |
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