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Highlights fom the 2022 Advanced Prostate Cancer Consensus Conference (APCCC) |
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High-Risk and Locally Advanced Prostate Cancer
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| Impact of Next Generation Imaging: What Is the Optimal (Current) Tracer for PET-Based Imaging for Staging |
| Ken Herrmann, MD, MBA |
| Ken Herrmann discusses the impact of next generation imaging and the optimal tracer for PET-based imaging for staging. To set the stage, Dr. Herrmann notes that we are nearly a decade since the first report of human application of PSMA PET/CT, with several available 68Ga-labeled PSMA ligands (68Ga-PSMA-11, 68Ga-PSMA-I&T) and 18F-labeled PSMA ligands. |
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| Are We Ready to Change Management Based on Next-Generation Imaging? YES
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| Jason Efstathiou, MD
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| The 2022 Advanced Prostate Cancer Consensus Conference (APCCC) Hybrid Meeting included a session on high-risk and locally advanced prostate cancer and a presentation by Dr. Jason Efstathiou arguing for changes in management based on next-generation imaging. Dr. Efstathiou started his presentation by highlighting that new technology is kind of like the Gartner’s Hype Cycle.
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| Are We Ready to Change Management Based on Next-Generation Imaging? NO |
| Nicolas Mottet, MD, Ph.D. |
| Nicolas Mottet argued that we are not ready for changes in management based on next-generation imaging. Dr. Mottet emphasized that what we are discussing is the everyday use of upfront PSMA PET/CT for staging, outside of a clinical trial, leading to guideline recommendations. |
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| Impact of Histology Variants (Ductal/Intraductal/Cribriform) on Treatment Recommendation |
| Declan G. Murphy, MB, BCH, BaO, FRACS, FRCS, Urol |
| Declan Murphy discusses the impact of histologic variants on treatment recommendations, particularly as it pertains to ductal, intraductal and cribriform histology. Dr. Murphy notes that pathology used to be quite simple, for example 10 years ago histology was scored as Gleason 6-10 and the number of cores were listed. However, today there has been several updates of the ISUP system (2014 and 2019), a grade group system, the percentage of pattern 4 present, the maximum core length, and utilization of genomic classifiers. |
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| Management of Clinical N1 Prostate Cancer (Including Systemic Therapy) |
| Darren MC Poon, FHKCR |
| Darren Poon discussed the management of clinical N1 (cN1) prostate cancer. Dr. Poon notes that with regards to contemporary radiotherapy for high-risk/cN1 prostate cancer, there is data available showing benefit of external beam radiotherapy, utilizing an intra-prostatic lesion boost (FLAME study), a brachytherapy boost (ASCENDE-RT study), whole-pelvic radiotherapy (POP-RT study), and MR-guided real-time adaptive radiotherapy with a nodal boost. |
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| Management of pN1 Prostate Cancer (Including Systemic Therapy)
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| Derya Tilki, MD
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| In this presentation, Derya Tilki discussed the management of pathologic N1 (pN1) prostate cancer. Dr. Tilki notes that according to the EAU guidelines, the uncertainty regarding the optimal management of pN1 disease is reflected in these guidelines, which list observation, adjuvant ADT, and radiotherapy ADT as management options.
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| Management of mHSPC |
| When Low-Volume on Conventional Imaging Goes Into High-Volume on Next-Generation Imaging in mHSPC - Treat like Low-Volume |
| Karim Fizazi, MD, PhD |
| Karim Fizazi discusses that when low-volume disease on conventional imaging becomes high-volume on next-generation imaging in mHSPC, we should treat these patients like low volume patients. Dr. Fizazi concluded his presentation by stating that at the end of the day, it will be most important to move away from the volume concept toward biomarker stratification as soon as possible. |
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| When Low-Volume on Conventional Imaging Goes into High-Volume on Next-Generation Imaging in mHSPC - Treat like High-Volume |
| Ian Davis, MD, PhD |
| Ian Davis discusses that when low-volume disease on conventional imaging becomes high-volume on next-generation imaging in mHSPC, we should treat these patients like high volume patients. Prof. Davis provides several take home messages including: Modern imaging is here to stay. Stage migration is not applicable if we are actually defining a different disease state. The caveat is that we do not know if the same rules apply for metachronous as for synchronous disease. We can now better select for treatment: (i) those that are most likely to benefit from therapy we should target for more effective therapy, and (ii) those that are least likely to benefit from therapy we should spare from unnecessary intensification and maybe even de-intensify treatment. |
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| Treatment of Vulnerable/Frail Patients with mHSPC |
| Alicia Morgans, MD, MPH |
| Alicia Morgans discusses the treatment of vulnerable/frail patients with mHSPC. Dr. Morgans notes that according to the NCCN guidelines we currently have a plethora of options for the treatment of mHSPC in 2022. However, there is still debate regarding the optimal treatment of newly diagnosed metastatic prostate cancer. |
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| Optimal Treatment for mHSPC from a Health Economics Standpoint |
| Caroline S. Clarke, Ph.D., MSci, BA (Hons) |
Caroline Clarke discussied the optimal treatment for mHSPC from a health economics standpoint. Health care resources are always limited and an economic evaluation helps to use them wisely, using transparent analyses
Routine collection of EQ-5D-5L data is helpful, particularly among patients that progress during a clinical trial. Over-treatment can be a problem, and more studies are required to identify where this occurs. Health economics can help drive funding for these studies to improve patient care. |
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