|
|
|
|
|
Highlights from the 2024 Advanced Prostate Cancer Consensus Conference |
|
|
|
|
|
High-Risk and Locally Advanced Prostate Cancer
|
|
| Genomic Classifiers and Artificial Intelligence as Predictors for Treatment Benefit |
| Daniel Spratt, MD |
| Daniel Spratt discussed the limitations of conventional risk stratification tools in prostate cancer, particularly the reliance on Gleason Score for treatment decisions. He emphasized the need for more personalized approaches using genomic classifiers like Decipher® and artificial intelligence (AI) tools to predict treatment benefit accurately.
|
|
|
|
|
|
| Radiation Therapy Schedules and Fields for High-Risk and Locally Advanced Prostate Cancer |
| Neha Vapiwala, MD, FACR, FASTRO, FASCO |
| Neha Vapiwala discussed contemporary radiation therapy approaches for high-risk and locally advanced prostate cancer. The session highlighted the benefits of dose escalation through various radiotherapy schedules, including moderate and ultrahypofractionation, which have shown improved outcomes such as biochemical progression-free and distant metastasis-free survival. |
|
|
|
|
|
| Debate: How to Best Manage a Fit Patient with High-Risk Localised and Locally Advanced Prostate Cancer? Surgery as Radical Local Treatment (As Part of a Multimodality Approach) |
| Alberto Briganti, MD, Ph.D. |
| Alberto Briganti argued in favor of surgery as part of a multimodal approach for managing fit patients with high-risk, localized, or locally advanced prostate cancer. He highlighted the potential benefits of surgery, such as tailored post-operative treatment and the ability to assess pathology for further treatment decisions. However, he acknowledged the lack of strong evidence from randomized controlled trials specifically supporting surgery in this context and emphasized the importance of personalized treatment decisions based on patient characteristics and disease characteristics. |
|
|
|
|
|
|
|
| Update on the IRONMAN Project |
| Alicia Morgans, MD, MPH, and Daniel George, MD |
| Alicia Morgans and Daniel George presented an update on the IRONMAN project at APCCC 2024 highlighting its progress in establishing a global registry of men with advanced prostate cancer, encompassing various disease stages. This initiative aims to collect comprehensive clinical and molecular data from over 2,000 patients across continents, with a focus on advancing research and clinical trials to improve outcomes and treatment strategies for advanced prostate cancer through international collaboration. |
|
|
|
|
|
|
Management of Metastatic Hormone-Sensitive Prostate Cancer
|
|
| In Which Patients with Synchronous Low-Volume mHSPC Do You Recommend “Total Therapy”? |
| Oliver Sartor, MD |
| Oliver Sartor discussed the management of metastatic hormone-sensitive prostate cancer (mHSPC) at APCCC 2024, focusing on "total therapy" for patients with low-volume disease. He emphasized the evolving role of molecular imaging, particularly PSMA PET, in redefining low-volume disease. |
|
|
|
|
|
| Should the Primary Be Treated in Synchronous High-Volume mHSPC |
| Sandy Srinivas, MD |
| Sandy Srinivas presented findings at APCCC 2024 regarding the management of synchronous high-volume metastatic hormone-sensitive prostate cancer (mHSPC). Key trials such as HORRAD and STAMPEDE Arm H examined the impact of radiotherapy on overall survival, with mixed results suggesting potential benefits in specific subgroups. These findings emphasize the need for personalized treatment approaches in synchronous high-volume mHSPC. |
|
|
|
|
|
| In Which Patients with Metachronous Low-volume mHSPC Do You Recommend “Total Therapy”? |
| Thomas Zilli, MD |
| Thomas Zilli discussed the role of "total therapy" with metastasis-directed therapy (MDT) in patients with metachronous low-volume metastatic hormone-sensitive prostate cancer (mHSPC) at APCCC 2024. The field of MDT is rapidly evolving, and risk stratification based on clinical factors and genomic profiling can help guide treatment decisions for patients with oligorecurrent or low-volume metachronous mHSPC. |
|
|
|
|
|
| Which Patients with mHSPC Can Be Offered a Treatment Break (De-Escalation Strategies) and How to Manage the Break?
|
| Bertrand Tombal, MD, Ph.D.
|
| Bertrand Tombal discussed strategies for offering treatment breaks (de-escalation) to patients with metastatic hormone-sensitive prostate cancer (mHSPC) at APCCC 2024. He highlighted ongoing trials assessing different approaches, such as discontinuing androgen receptor-targeted agents (ARTA) while continuing ADT, or stopping ADT while maintaining ARTA.
|
|
|
|
|
|
| Escalation Strategies in Patients with mHSPC and an Unfavourable PSA Decline – Is More Better?
|
| Mary-Ellen Taplin, MD
|
| Mary-Ellen Taplin discussed escalation strategies for patients with metastatic hormone-sensitive prostate cancer (mHSPC) and an unfavorable PSA decline at APCCC 2024. She emphasized that an unfavorable PSA decline should not be equated with disease progression and highlighted the prognostic significance of PSA nadir in assessing treatment response.
|
|
|
|
|
|
| How to Manage Patients with Low-Volume on Conventional and High-Volume on NGI
|
| Dana Rathkopf, MD
|
| Dana Rathkopf discussed the management of patients with low-volume disease on conventional imaging and high-volume disease on next-generation imaging at APCCC 2024. She highlighted the complexities of integrating next-generation imaging like PSMA PET/CT into the current treatment paradigm for mHSPC. Dr. Rathkopf emphasized caution in retrofitting PSMA PET findings into conventional imaging-defined volume subgroups and underscored the importance of using clinical subgroups to guide treatment decisions rather than solely relying on imaging results.
|
|
|
|
|
|
| Management of Patients with mHSPC and Early Progression on Combination Therapy
|
| Christopher Sweeney, MBBS
|
| Christopher Sweeney's presentation at APCCC 2024 focused on the management of patients with metastatic hormone-sensitive prostate cancer (mHSPC) and early progression on combination therapy. He emphasized the importance of personalized medicine in selecting the best first-line treatment for each patient based on individual and tumor characteristics.
|
|
|
|
|
|
|
|
|
|
|
| Management of Frail Patients with mHSPC
|
| Maria De Santis, M, Ph.D.
|
| Maria De Santis presented on managing frail patients with metastatic hormone-sensitive prostate cancer (mHSPC) at APCCC 2024. Frailty is defined by specific criteria including components related to nutrition, energy, physical activity, strength, and mobility. Dr. De Santis emphasized the importance of personalized care based on frailty status, life expectancy, and patient goals, suggesting treatment strategies that prioritize quality of life and patient safety.
|
|
|
|
|
|
| Future Changes in the Setting of mHSPC
|
| Gerhardt Attard, MD, Ph.D.
|
| Gerhardt Attard presented at the 2024 Advanced Prostate Cancer Consensus Conference (APCCC), discussing future changes in the management of metastatic hormone-sensitive prostate cancer (mHSPC). He emphasized ongoing phase 3 trials investigating treatment strategies for M1 prostate cancer starting ADT. Dr. Attard highlighted the importance of biomarkers, including genomic tests like Decipher, to guide treatment decisions and predict therapeutic response in this patient population.
|
|
|
|
|
|
| Management of Metastatic CRPC |
| When to Do Tumour Genomic Profiling in Advanced Prostate Cancer and What?
|
| Niven Mehra, MD, Ph.D.
|
| In the management of Metastatic CRPC session, Dr. Niven Mehra discussed tumor genomic profiling in advanced prostate cancer, noting guidance from EAU, ESMO, NCCN, and APCCC on testing criteria.
|
|
|
|
|
|
|
|
|
|
|
| Ideal Sequence After ADT Alone or ADT plus ARPI for mHSPC
|
| Ian Davis, MBBS(Hons), Ph.D., FRACP, FAChPM, FAHMS, GAICD
|
| In the management of Metastatic CRPC session, Dr. Ian Davis addressed treatment sequencing post-ADT in mHSPC, underscoring the absence of an ideal sequence. He noted challenges and the complexity of NCCN guidelines, which offer numerous options based on prior therapy.
|
|
|
|
|
|
