CUA 2018: Metastatic Castration-Resistant Prostate Cancer Treatment Algorithm: A Shifting Paradigm

Halifax, Nova Scotia ( There is a growing number of treatment options available for metastatic prostate cancer (PC), and it is now possible to sequence multiple lines of therapies over the course of the disease. Therefore, there is a need to incorporate emerging trial evidence to develop a treatment algorithm to support physicians treating these patients. Bobby Shayegan, MD, presented their work on the creation of such a practical algorithm, to help guide treatment in metastatic castrate-resistant prostate cancer (MCRPC) patients. 

This project was an initiative of the GU research Consortium (GURC).  This is a national collaboration of uro-oncologists, medical oncologists, and radiation oncologists who treat advanced PC with a common interest in research, education and best practice.

The development of this algorithm was a very rigorous process and entailed a review of all contemporary guidelines, including NCCN, ASCO AUA, EAU, and CUA. The algorithm incorporated data from the COU-301, COU-302, PREVAIL, AFFIRM, TAX 327, TROPIC, and ALSYMPCA trials. The new algorithm is demonstrated in figure 1. 

Figure 1- Proposed treatment algorithm:
UroToday CUA 2018 Proposed treatment algorithm
The algorithm was developed as a practical tool to guide therapy. Its development was informed by clinical evidence and multidisciplinary expert consensus. This algorithm should not be considered definitive or replace evidence-based clinical guidelines or consensus statements. It does not address sequencing from metastatic castrate sensitive status to mCRPC status. Importantly, since the mCRPC algorithm was developed by a national panel of multidisciplinary experts, some provinces may not have funding policies that match the algorithm.

Shayegan also mentioned that another algorithm for biochemical recurrence following radical therapy, and non-metastatic CRPC were created to provide guidance earlier in therapy. Additionally, a management algorithm for newly diagnosed metastatic hormone-sensitive prostate cancer is being finalized.

Presented by: Bobby Shayegan, MD, Associate Professor and Head, McMaster University, Hamilton, Canada

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia