|
|
|
|
|
Highlights from the 2022 Advanced Prostate Cancer Consensus Conference (APCCC) |
|
|
|
|
|
Management of Non-Metastatic CRPC
|
|
| Disadvantages of Using Novel Imaging in nmCRPC
|
| Alberto Briganti, MD, Ph.D.
|
| Alberto Briganti discussed the disadvantages of using novel imaging in this disease space. Novel imaging approaches represent sensitive options to detect metastatic sites in men with CRPC. The proven benefit of using novel imaging approaches is unclear given the lack of evidence based on all mentioned limitations regarding patient selection, imaging interpretation and standardization, prospective data of metastasis directed therapy and follow-up assessment.
|
|
|
|
|
|
| Genomic and Clinical Markers in nmCRPC
|
| Joaquin Mateo, MD, Ph.D.
|
| Joaquin Mateo discussed genomic and clinical markers in this disease space. Dr. Mateo noted that nmCRPC may or may not be traversed as patients pass through the prostate cancer disease continuum. Therapeutic indication for ADT versus ADT + ARI in nmCRPC is based on prognostic (imaging + PSA doubling time) markers; further research could identify others (including clinical variables, PSA kinetics, pathology features) that could help refine stratification.
|
|
|
|
|
|
| Treatment of the Primary of or Local Relapse in nmCRPC
|
| Pierre Blanchard, MD
|
| Pierre Blanchard discusses treatment of the primary or local relapse in this disease space. Dr. Blanchard notes that based on previous APCCC reports, several important statements were made: “a combined total of 86% of panelists voted for consideration of salvage radiation therapy over systemic therapy in either most (54%) or selected (32%) patients with local recurrence, despite a lack of data supporting such an approach.”
|
|
|
|
|
|
|
|
|
|
|
|
Management of Metastatic CRPC
|
|
| Tumor Genomic Profiling: What Is Relevant and How To Avoid Potential Pitfalls? |
| Colin C. Pritchard, MD, Ph.D. |
| Colin Pritchard presented on the role of tumor genomic profiling, and the potential pitfalls. He first enumerated a potentially emerging model for patients with prostate cancer in which germline, tumor-, and liquid-biopsies are evaluated in order to inform treatment decisions (guided by germline and somatic findings). Further, these findings allow for genetic counselling of family members. |
|
|
|
|
|
| How To Read a Genomic Testing Report |
| Kim Chi, MD |
| Kim Chi presented on the mundane but critical task of reading a genomics report. He emphasized that this is increasingly important as clinicians, rather than genetic counsellors, are ordering testing more and more commonly. It’s notable that most clinicians report no formal training in the interpretation or communication of tumor genomic profiling results and risks. |
|
|
|
|
|
| Aggressive Variant Prostate Cancer: Definition, Diagnosis, Treatment |
| Eric Small, MD |
Eric Small discussed aggressive variant prostate cancer and treatment-associated small cell/neuroendocrine prostate cancer (t-SCNC). Dr. Small highlighted the importance of biopsy where possible as neither disease distribution nor PSA are diagnostic of AVPC or t-SCNC. Platinum-based chemotherapy is warranted, with cabazitaxel and carboplatin showing a modest advantage to cabazitaxel alone. However, whenever possible, clinical trials should be considered for this rare and aggressive subset of prostate cancer.
|
|
|
|
|
|
| Risk-Adapted Treatment Monitoring in mCRPC |
| Anwar Padhani, MBBS, FRCP, FRCR |
| Anwar Padhani discussed imaging-based treatment monitoring in prostate cancer. Dr. Padhani noted that discordance between clinical and imaging assessment for disease progression are common. Thus, vigilance is needed for regular, protocol-based assessment. The management implications and survival effects of using next generation imaging have yet to be established in the context of treatment monitoring. Thus, prospective trials remain important. |
|
|
|
|
|
|
Oligometastatic and Oligoprogressive Prostate Cancer
|
|
| What is the Evidence of MDT in Synchronous vs Metachronous mHSPC? |
| Daniel Spratt, MD |
| Daniel Spratt discussed the evidence for metastasis directed therapy (MDT) in patients with synchronous and metachronous metastatic hormone sensitive prostate cancer (mHSPC). In terms of level-setting, he began by highlighting the landscape of oligometastatic cancer, with a focus on the top right corner (synchronous oligometastatic disease, metachronous oligorecurrent or oligoprogressive disease). |
|
|
|
|
|
| What Is the Evidence of Systemic Therapies (Alone or in Combination With MDT) in Oligometastatic mHSPC? |
| Mary Ellen Taplin, MD |
| Mary Ellen Taplin discussed the role of systemic therapy in this disease state. Moving forward, she noted that the study of oligometastatic disease represents a unique subset. Currently, there remains a need to better understand the biology within this disease space to guide biomarker design and discover and identify optimal treatment approaches. |
|
|
|
|
|
| Are There Predictors for Successful Treatment of Oligometastatic Prostate Cancer? |
| Piet Ost, MD, Ph.D. |
| Ost examined whether we have predictors for the successful treatment of patients with oligometastatic prostate cancer. Dr. Ost emphasized that a radiographic definition of disease volume is predictive of the success of primary prostate radiotherapy in de novo mHSPC, though there are no data for MDT. In recurrent disease, he emphasized the importance of using the most sensitive imaging available. |
|
|
|
|
|
| How to Interpret and Confirm Lesions Positive on PSMA PET but with No Correlate on CT?
|
| Stefano Fanti, MD
|
| Stefano Fanti presented on how to interpret and confirm lesions detected on PSMA-PET that don’t have correlates on conventional imaging. Dr. Fanti emphasized that PSMA-PET based imaging is a game changer in the management of patients with prostate cancer. However, ongoing work is required to ensure that this technology is maximally used for the benefit of our patients. He highlighted the value of multidisciplinary tumor boards as clinical data may often be useful in clarifying diagnoses for interpreting nuclear medicine physicians.
|
|
|
|
|
|
| How to Follow-Up Patients Who had PSMA PET as Baseline Imaging
|
| Tomasz M. Beer, MD, FACP
|
| Tomasz discussed the question of how to follow patients in whom PSMA-PET imaging has been used for baseline staging or diagnostic imaging. Dr. Beer emphasized that there are many outstanding questions regarding the use of PSMA-PET/CT response criteria, some of which have been addressed in a recent consensus statement. However, he felt that the use of this approach is nearly inevitable.
|
|
|
|
|
|
| Does “Oligoprogressive” Prostate Cancer Exist as a Distinct Clinically Meaningful Entity and if Yes, How To Treat It?
|
| Robert Jones, MD
|
| Robert Jones presented the final talk of this year’s APCCC meeting discussing whether “oligoprogressive” prostate cancer exists as a distinct clinical entity. he highlighted that he believes that oligoprogression exists, though it is poorly defined with current imaging approaches. While imaging is critical to guiding lesion-directed therapy, a better understanding of the biology of systemic therapy resistance is needed, given its central role in the therapeutic hypothesis.
|
|
|
|
|
|
|
