advanced prostate cancer consensus questions 2017 questions... · 2 - imaging after 6 months...

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Published open access in European Urology

http://dx.doi.org/10.1016/j.eururo.2017.06.002

Advanced Prostate Cancer Consensus Questions: Section 5

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What imaging test is sufficient to “exclude” distant metastases in high-risk and locally-advanced prostate cancer?

0

Management of high-risk and locally-advanced M0 prostate cancer

1 - Bone scintigraphy alone

2 - CT alone

3 - Combination of bone scintigraphy and CT

4 - Whole body MRI

5 – PET-CT (PSMA, Choline or FACBC (Fluciclovine))

6 - Abstain

7 - Unqualified to answer

Opt Votes

1 0

2 0

3 20

4 5

5 18

6 6

7 0

N 49

41%

10%

37%

12%

Option 1

Option 2

Option 3

Option 4

Option 5

Option 6

Detailed voting

results

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In which men with isolated rising PSA alone after prostatectomy do you recommend imaging (including next generation imaging) before starting salvage radiation therapy?

Salvage Radiation therapy for isolated rising PSA alone after prostatectomy

0

1 - In the majority of patients, independent of PSA level

2 - Only in patients with PSA >0.5 ng/mL

3 - Only in patients with PSA >1 ng/mL

4 - Only in patients with PSA >2 ng/mL

5 - No imaging

6 - Abstain


Opt Votes

1 21

2 14

3 6

4 6

5 0

6 1

7 0

N 48

44%

29%

12%

13%

2%

Option 1

Option 2

Option 3

Option 4

Option 5

Option 6

Detailed voting

results

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In men with potentially de novo oligometastatic disease what imaging do you recommend to confirm this diagnosis (apart from local staging)?

1 - CT and/or MRI and bone scintigraphy

2 - PET-CT (PSMA, Choline or FACBC (Fluciclovine))

3 - WB-MRI

4 - Either PET-CT or WB-MRI (next generation imaging)

5 - Abstain


De novo oligometastatic disease (no prior prostate treatment)

0

Opt Votes

1 13

2 17

3 2

4 17

5 1

6 0

N 50

26%

34% 4%

34%

2%

Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

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What imaging modality do you recommend to diagnose the oligometastatic recurrent state for men with castration-sensitive/naive prostate cancer after local treatment with curative intent (+/- salvage radiation therapy)?

Oligometastatic recurrence in castration-sensitive/naive prostate cancer patients with a rising PSA after local treatment (EBRT or RP ± EBRT) with curative intent (+/- salvage radiation therapy)

0



3 - Whole-body MRI

4 - Pelvic MRI + PET-CT (PSMA, Choline or FACBC (Fluciclovine))

5 - Pelvic MRI + whole-body MRI

6 - Abstain (including I do not believe that the oligometastatic recurrent state is a clinically meaningful entity)


Opt Votes

1 11

2 23

3 1

4 12

5 2

6 2

7 0

N 51

Detailed voting

results

22%

47%

2%

25%

4%

Option 1

Option 2

Option 3

Option 4

Option 5

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In men with oligometastatic CRPC what imaging do you recommend to confirm this diagnosis?

Rising PSA on ADT (mCRPC) and oligometastatic disease

0



3 - Whole-body MRI

4 - Pelvic MRI + PET-CT (PSMA, Choline or FACBC (Fluciclovine))

5 - Pelvic MRI + whole-body MRI

6 - Abstain (including I do not believe that oligometastatic prostate cancer is a clinically meaningful entity in mCRPC)


Opt Votes

1 13

2 24

3 3

4 9

5 1

6 1

7 0

N 51

Detailed voting

results

26%

48%

6%

18%

2%

Option 1

Option 2

Option 3

Option 4

Option 5

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All mentioned imaging options are available What monitoring by imaging do you recommend for the majority of men with metastatic castration-sensitive/naive prostate cancer?

0

General imaging

1 - Baseline imaging and regular monitoring by imaging every 3-6 months

2 - Baseline imaging and follow-up imaging at PSA nadir/completion of 6 cycles of Docetaxel as part of chemo-hormonal therapy and again at progression (confirmed PSA rise and/or clinical progression)

3 - Baseline imaging only and monitoring by PSA alone and imaging at progression

4 - Abstain


Opt Votes

1 16

2 26

3 9

4 0

5 0

N 51

31%

51%

18%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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What kind of imaging do you recommend for the majority of men with metastatic castration-sensitive/naive prostate cancer?

0

General imaging

1 - CT and bone scintigraphy

2 - CT alone


4 - Next generation imaging for prostate cancer

5 - Abstain


Opt Votes

1 37

2 0

3 0

4 13

5 1

6 0

N 51 73%

25%

2%

Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

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What monitoring by imaging do you recommend for the majority of men on first-line mCRPC therapy?

0

General imaging

1 - Baseline imaging and regular monitoring by imaging every 3-6 months

2 - Baseline imaging and follow-up imaging at PSA nadir and again at progression (confirmed PSA rise and/or clinical progression)

3 - Baseline imaging only and monitoring by PSA alone and imaging at progression

4 - Abstain


Opt Votes

1 27

2 14

3 8

4 1

5 0

N 50 54% 28%

16%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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What kind of imaging do you recommend for the majority of men with mCRPC on first-line therapy?

0

General imaging


2 - CT alone



5 - Abstain


Opt Votes

1 38

2 1

3 0

4 12

5 0

6 0

N 51

74%

2%

24% Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

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How frequently do you repeat imaging for treatment monitoring in men with mCRPC on treatment with Radium-223?

0

In men with mCRPC treated with Radium-223

1 - Every 3-4 months during and after treatment

2 - Imaging after 6 months (completion of Radium-223 treatment) and every 3-4 months thereafter

3 - Imaging after 6 months (completion of Radium-223 treatment) andfollow-up imaging at progression (clinical or biochemical progression)

4 - Only at progression (clinical or biochemical progression)

5 - Abstain


Opt Votes

1 20

2 13

3 12

4 2

5 2

6 0

N 49

41%

27%

24%

4% 4%

Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

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What kind of imaging for staging and treatment monitoring do you recommend for the majority of men with mCRPC on treatment with Radium-223?

0


2 - CT alone



5 - Abstain


In men with mCRPC treated with Radium-223

Opt Votes

1 35

2 0

3 0

4 11

5 1

6 0

N 47 75%

23%

2%

Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

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Which osteoclast-targeted therapy do you recommend for men with mCRPC and bone metastases for SRE/SSE prevention?

0

Best use of osteoclast-targeted therapy for SRE/SSE prevention for mCRPC (NOT for osteoporosis/bone loss)

1 - Zoledronic acid

2 - Denosumab

3 - Either Zoledronic acid or Denosumab

4 - Another osteoclast-targeted therapy

5 - I do not use osteoclast-targeted therapy in this setting

6 - Abstain


Opt Votes

1 4

2 27

3 12

4 2

5 5

6 0

7 0

N 50

8%

54%

24%

4% 10%

Option 1

Option 2

Option 3

Option 4

Option 5

Option 6

Detailed voting

results

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When you use osteoclast-targeted therapy (zoledronic acid or denosumab) in men with mCRPC and bone metastases, what treatment duration do you recommend?

0


1 - Approximately 2 years

2 - Indefinitely

3 - Abstain (including I do not use osteoclast-targeted therapy in this setting)


Opt Votes

1 30

2 14

3 6

4 0

N 50

68%

32%

Option 1

Option 2

Detailed voting

results

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For the majority of asymptomatic men with mCRPC and bone metastases responding to first-line systemic mCRPC treatment, which schedule do you recommend for osteoclast-targeted therapy (zoledronic acid or denosumab) in the absence of significant toxicity?

0


1 - Every 4 weeks

2 - Every 4 weeks until approximately two years, then less frequently

3 - Every 3 months

4 - Every 6-12 months

5 - No osteoclast-targeted therapy while responding to first-line mCRPC therapy



Opt Votes

1 8

2 18

3 7

4 2

5 13

6 1

7 2

N 51

17%

37% 15%

4%

27% Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

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For the majority of asymptomatic men with mCRPC and bone metastases NOT responding to first-line systemic mCRPC treatment, which schedule do you recommend for osteoclast-targeted therapy (zoledronic acid or denosumab) in the absence of significant toxicity?

0


1 - Every 4 weeks

2 - Every 4 weeks until approximately two years, then less frequently

3 - Every 3 months

4 - Every 6-12 months



Opt Votes

1 12

2 24

3 7

4 2

5 5

6 1

N 51

27%

53%

16%

4%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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What do you recommend for the majority of men with mCRPC and multiple bone metastases who develop osteonecrosis of the jaw while on osteoclast-targeted therapy for SRE/SSE prevention?

0


1 - Continue osteoclast-targeted therapy

2 - Discontinue osteoclast-targeted therapy permanently

3 - Discontinue osteoclast-targeted therapy and re-start after complete wound healing

4 - Abstain


Opt Votes

1 0

2 41

3 8

4 0

5 1

N 50

84%

16%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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In your opinion, is AR-V7 testing ready for use in daily routine clinical practice for the majority of men with mCRPC?

0

AR-V7/AR amplification/mutation

1 - Yes

2 - No

3 - Abstain


Opt Votes

1 2

2 50

3 0

4 0

N 52

4%

96%

Option 1

Option 2

Option 3

Detailed voting

results

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In your opinion, are cell-free DNA AR amplification and AR mutation testing ready for use in daily routine clinical practice for the majority of men with mCRPC?

0

AR-V7/AR amplification/mutation

1 - Yes

2 - No

3 - Abstain


Opt Votes

1 4

2 47

3 0

4 0

N 51

8%

92%

Option 1

Option 2

Option 3

Detailed voting

results

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In routine daily clinical practise do you recommend DNA sequencing of tumour biopsies in the majority of men with mCRPC?

0

Tumour biopsy reporting

1 - Yes, whole genome or exome sequencing

2 - Yes, targeted/panel sequencing

3 - No

4 - Abstain


Opt Votes

1 2

2 19

3 30

4 0

5 0

N 51

4%

37%

59%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. PSA IHC

0

1 - Yes, useful test for majority of patients (influences your management decision)

2 - Only for minority of selected patients

3 - No

4 - Abstain


Advanced Prostate Cancer Tumour Biopsy

Opt Votes

1 37

2 9

3 5

4 0

5 1

N 52

72%

18%

10%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. Prostate acid phosphatase

0



3 - No

4 - Abstain



Opt Votes

1 13

2 9

3 27

4 1

5 1

N 51

26%

18% 54%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. NKX3.1

0



3 - No

4 - Abstain



Opt Votes

1 6

2 16

3 24

4 3

5 2

N 51

12%

33% 49%

6%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. AR-V7

0



3 - No

4 - Abstain



Opt Votes

1 17

2 13

3 19

4 2

5 1

N 52

33%

26%

37%

4%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. Nuclear AR

0



3 - No

4 - Abstain



Opt Votes

1 17

2 9

3 23

4 1

5 2

N 52

34%

18%

46%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. AR amplification and/or AR mutation

0



3 - No

4 - Abstain



Opt Votes

1 21

2 9

3 18

4 1

5 2

N 51

43%

18%

37%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. PSMA

0



3 - No

4 - Abstain



Opt Votes

1 16

2 11

3 22

4 1

5 2

N 52

32%

22%

44%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. Ki67/MiB1

0



3 - No

4 - Abstain



Opt Votes

1 14

2 13

3 21

4 2

5 2

N 52

28%

26%

42%

4%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. Chromogranin, Synaptophysin, CD56/NSE

0



3 - No

4 - Abstain



Opt Votes

1 24

2 15

3 8

4 1

5 2

N 50

50%

31%

17%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. ERG IHC

0



3 - No

4 - Abstain



Opt Votes

1 6

2 15

3 28

4 1

5 2

N 52

12%

30%

56%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. ERG FISH

0



3 - No

4 - Abstain



Opt Votes

1 5

2 11

3 30

4 1

5 2

N 49

11%

23%

64%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. Loss of PTEN

0



3 - No

4 - Abstain



Opt Votes

1 22

2 13

3 13

4 2

5 2

N 52

44%

26%

26%

4%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. BRCA1, BRCA2 and ATM mutation

0



3 - No

4 - Abstain



Opt Votes

1 39

2 10

3 1

4 0

5 2

N 52 78%

20%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. Other DNA repair genes (e.g. CHEK2, PALB2 and others)

0



3 - No

4 - Abstain



Opt Votes

1 32

2 11

3 6

4 1

5 2

N 52 64%

22%

12%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. TP53 and RB1

0



3 - No

4 - Abstain



Opt Votes

1 17

2 11

3 20

4 2

5 2

N 52

34%

22%

40%

4%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. PD-1/PD-L1

0



3 - No

4 - Abstain



Opt Votes

1 11

2 15

3 22

4 1

5 2

N 51

22%

31%

45%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



As a clinician, which factors do you want to have reported back to you in men with mCRPC who undergo a metastatic tumour biopsy apart from tumour morphology and differentiation? The question is only about management for a specific patient not about familial implications and based on knowledge March 2017 in terms of test accuracy/validity and available treatments. MMR gene alterations (MSI, MMR protein IHC, or by direct sequencing)

0



3 - No

4 - Abstain



Opt Votes

1 27

2 11

3 10

4 2

5 2

N 52

54%

22%

20%

4%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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If you recommend testing for somatic alterations involving DNA repair defects for men with mCRPC and no recent mCRPC tissue biopsy is available what do you recommend?

0

DNA repair testing in daily routine clinical practice

1 - Test in archival primary tumour tissue

2 - A fresh mCRPC tumour biopsy is needed

3 - Test in circulating tumour DNA

4 - Abstain (including I do not recommend testing in this situation)


Opt Votes

1 7

2 30

3 6

4 7

5 1

N 51

16%

70%

14%

Option 1

Option 2

Option 3

Detailed voting

results

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If the substances were available and approved: Would you recommend treatment with Olaparib or another PARP inhibitor in men with mCRPC and presence of DNA repair defects (germline or somatic) based on the Phase II data with Olaparib?

0


1 - Yes, in the majority patients

2 - In a minority of selected patients

3 - No

4 - Abstain


Opt Votes

1 33

2 15

3 2

4 1

5 0

N 51

65%

29%

4% 2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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In men with mCRPC and presence of DNA repair defects (germline or somatic) is it appropriate to extrapolate the Phase II data from Olaparib to Platinum agents?

0




3 - No

4 - Abstain


Opt Votes

1 23

2 7

3 18

4 3

5 0

N 51

45%

14%

35%

6%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



In men with mCRPC and a presence of DNA repair defects (germline or somatic) progressing on ADT (castration-resistance), which first-line mCRPC treatment do you recommend?

0


1 - Standard mCRPC first-line treatment option

2 - Platinum based combination chemotherapy

3 - Platinum monotherapy

4 - PARP inhibitor

5 - Abstain


Opt Votes

1 34

2 11

3 0

4 5

5 1

6 1

N 52 67%

21%

10%

2%

Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

www.apccc.org



In men with mCRPC and presence of DNA repair defects (germline or somatic) progressing on/after standard first-line mCRPC therapy, which second-line treatment do you recommend?

0


1 - Standard CRPC second-line treatment option

2 - Platinum based combination chemotherapy

3 - Platinum monotherapy

4 - PARP inhibitor

5 - Abstain (including I do not use standard mCRPC treatment in these men)


Opt Votes

1 16

2 19

3 2

4 10

5 1

6 1

N 49

Detailed voting

results

33%

40%

4%

21%

2%

Option 1

Option 2

Option 3

Option 4

Option 5

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Do you recommend genetic counselling and testing for men with newly diagnosed metastatic (M1) prostate cancer?

0

Germline and genetic counselling in daily clinical practice

1 - Yes, in the majority of patients


3 - No

4 - Abstain


Opt Votes

1 10

2 31

3 9

4 0

5 0

N 50

20%

62%

18%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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If you voted for a minority of selected patients, which factors influence your selection? Positive family history for prostate cancer?

0

1 - Yes

2 - No

3 - Abstain (including I did not vote for a minority of patients)



Opt Votes

1 37

2 2

3 9

4 0

N 48

95%

5%

Option 1

Option 2

Detailed voting

results

www.apccc.org



If you voted for a minority of selected patients, which factors influence your selection? Positive family history for other cancer syndromes (e.g. hereditary breast and ovarian cancer syndrome and/or pancreatic cancer, or Lynch syndrome)?

0

1 - Yes

2 - No




Opt Votes

1 42

2 3

3 7

4 0

N 52

93%

7%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



If you voted for a minority of selected patients, which factors influence your selection? Younger age (≤60 years) at diagnosis?

0

1 - Yes

2 - No




Opt Votes

1 32

2 11

3 9

4 0

N 52

74%

26%

Option 1

Option 2

Detailed voting

results

www.apccc.org



If you ever recommend germline genetic testing, what do you test in men with prostate cancer?

0


1 - BRCA1 and BRCA2 testing only

2 - BRCA1, BRCA2 and ATM testing only

3 - Large panel testing including homologous recombination DNA repair (e.g. panels that are also used to assess breast cancer risk)

4 - Large panel testing including homologous recombination AND mismatch DNA repair (e.g. comprehensive cancer risk assessment panels)

5 - Abstain (including I do not recommend germline genetic testing)


Opt Votes

1 7

2 7

3 4

4 28

5 3

6 2

N 51

15%

15%

9% 61%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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Do you recommend a prophylactic prostatectomy in the presence of a germline BRCA1, BRCA2 or ATM mutation?

0




3 - No

4 - Abstain


Opt Votes

1 0

2 4

3 48

4 0

5 0

N 52

8%

92%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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Does the presence of a germline BRCA1, BRCA2 or ATM mutation in men with intermediate or high-risk localized prostate cancer influence your treatment decision?

0


1 - Yes, recommend radical prostatectomy over radiation therapy

2 - Yes, recommend radiation therapy over radical prostatectomy

3 - No, standard treatment recommendation

4 - Abstain (including other treatment recommendation)


Opt Votes

1 26

2 2

3 22

4 0

5 2

N 52

52%

4%

44% Option 1

Option 2

Option 3

Option 4

Detailed voting

results

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Does the presence of a germline BRCA1, BRCA2 or ATM mutation in men with low-risk localized prostate cancer influence your treatment decision?

0


1 - Yes, not recommend active surveillance

2 - Yes, other treatment recommendation


4 - Abstain


Opt Votes

1 23

2 10

3 18

4 0

5 0

N 51

45%

20%

35% Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



Does the presence of DNA repair defects (germline or somatic) in men with newly-diagnosed metastatic castration-sensitive/naive prostate cancer influence your upfront treatment decision for men with metastatic disease?

0


1 - Yes, more likely to recommend addition of Docetaxel to ADT

2 - Yes, include Platinum in the chemo-hormonal therapy

3 - Yes, other treatment recommendation


5 - Abstain


Opt Votes

1 12

2 11

3 2

4 25

5 1

6 0

N 51

23%

22%

4%

49%

2%

Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

www.apccc.org




www.apccc.org



What do you advise patients about the relationship between ADT and risk of bone loss and/or fractures?

0

Side effects of systemic treatment: Prevention and management

1 - There is strong evidence that ADT increases risk of bone loss and/or fractures

2 - There is moderate evidence that ADT increases risk of bone loss and/or fractures

3 - There is weak evidence that ADT increases risk of bone loss and/or fractures

4 - ADT does not change the risk of bone loss and/or fractures

5 - Abstain


Opt Votes

1 45

2 7

3 0

4 0

5 0

6 0

N 52 87%

13% Option1Option2Option3

Detailed voting

results

www.apccc.org



Do you recommend a baseline measurement of Vitamin D in men with prostate cancer starting on ADT?

0




3 - No

4 - Abstain


Opt Votes

1 22

2 13

3 16

4 0

5 0

N 51

43%

26%

31% Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



Do you recommend routine supplementation of calcium and Vitamin D in the majority of men with prostate cancer starting on ADT?

0


1 - Yes both (Calcium + Vitamin D)

2 - Only Vitamin D

3 - Only Calcium

4 - No

5 - Abstain


Opt Votes

1 38

2 7

3 1

4 6

5 0

6 0

N 52 73%

13%

2% 12%

Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

www.apccc.org



Do you recommend a baseline measurement of bone mineral density in men with prostate cancer starting on ADT?

0



2 - Only in patients with non-metastatic disease

3 - No

4 - Abstain


Opt Votes

1 32

2 8

3 11

4 1

5 0

N 52

62% 15%

21%

2%

Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

www.apccc.org



Do you recommend drug therapy to prevent bone loss and/or fractures with denosumab or a bisphosphonate in the dose and schedule for osteoporosis prophylaxis in men with prostate cancer starting on ADT?

0



2 - Only in patients with documented osteopenia or osteoporosis

3 - No

4 - Abstain


Opt Votes

1 8

2 36

3 6

4 1

5 0

N 51

16%

70%

12%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



What do you advise patients about the relationship between ADT and risk of diabetes?

0


1 - There is strong evidence that ADT increases risk of diabetes

2 - There is moderate evidence that ADT increases risk of diabetes

3 - There is weak evidence that ADT increases risk of diabetes

4 - ADT does not change the risk of diabetes

5 - Abstain


Opt Votes

1 18

2 24

3 9

4 1

5 0

6 0

N 52

35%

46%

17%

2%

Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

Detailed voting

results

www.apccc.org



What do you advise patients about the relationship between ADT and risk of cardiovascular disease?

0


1 - There is strong evidence that ADT increases risk of cardiovascular disease

2 - There is moderate evidence that ADT increases risk of cardiovascular disease

3 - There is weak evidence that ADT increases risk of cardiovascular disease

4 - ADT does not change the risk of cardiovascular disease

5 - Abstain


Opt Votes

1 6

2 20

3 23

4 2

5 0

6 0

N 51

12%

39%

45%

4%

Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

www.apccc.org



Does a history of recent/severe cardiovascular disease influence your choice of ADT in men with metastatic prostate cancer?

0




3 - No

4 - Abstain


Opt Votes

1 15

2 21

3 14

4 1

5 0

N 51

29%

41%

28%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



If you voted yes that a history of recent/severe cardiovascular disease influences your choice of ADT, what modality of ADT do you recommend in these men?

0


1 - LHRH agonist

2 - LHRH antagonist

3 - Orchiectomy

4 - Any form of intermittent ADT

5 - I avoid ADT and prescribe Bicalutamide 150 mg/day

6 - Abstain (including I did not vote yes)


Opt Votes

1 4

2 18

3 2

4 7

5 4

6 15

7 1

N 51

11%

52% 6%

20%

11%

Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

www.apccc.org



What do you advise patients about the relationship between ADT and risk of cognitive changes and/or dementia?

0


1 - There is strong evidence that ADT increases risk of cognitive changes and/or dementia

2 - There is moderate evidence that ADT increases risk of cognitive changes and/or dementia

3 - There is weak evidence that ADT increases risk of cognitive changes and/or dementia

4 - ADT does not change the risk of cognitive changes and/or dementia

5 - Abstain


Opt Votes

1 4

2 15

3 26

4 7

5 0

6 0

N 52

8%

29%

50%

13%

Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

www.apccc.org



What do you advise patients about the relationship between ADT and risk of depression?

0


1 - There is strong evidence that ADT increases risk of depression

2 - There is moderate evidence that ADT increases risk of depression

3 - There is weak evidence that ADT increases risk of depression

4 - ADT does not change the risk of depression

5 - Abstain


Opt Votes

1 3

2 24

3 23

4 2

5 0

6 0

N 52

6%

46% 44%

4%

Option 1

Option 2

Option 3

Option 4

Option 5

Detailed voting

results

www.apccc.org



Do you recommend regular physical exercise in men with prostate cancer starting on ADT?

0




3 - No

4 - Abstain


Opt Votes

1 50

2 1

3 0

4 0

5 0

N 51

98%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



Do you recommend to routinely involve a multidisciplinary team for prevention or management of ADT related adverse effects?

0




3 - No

4 - Abstain


Opt Votes

1 22

2 20

3 9

4 1

5 0

N 52

42%

39%

17%

2%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



In men with mCRPC do you recommend early access to an expert in symptom palliation or a dedicated palliative care service?

0

Supportive care

1 - Yes

2 - No

3 - Abstain


Opt Votes

1 31

2 20

3 0

4 0

N 51 61%

39% Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



Do you recommend access to opiate pain medication for men with metastatic prostate cancer and severe pain when their lower level pain medication is not sufficient?

0

Supportive care

1 - Yes

2 - No

3 - Abstain


Opt Votes

1 48

2 3

3 0

4 0

N 51

94%

6%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



Do you recommend a health status assessment in men with advanced prostate cancer ≥70 years before treatment decision?

0

Supportive care



3 - No

4 - Abstain


Opt Votes

1 15

2 21

3 12

4 2

5 0

N 50

30%

42%

24%

4%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



If you recommend a health status assessment in men with advanced prostate cancer ≥70 years which one do you recommend?

0

Supportive care

1 - Health status assessment by Comprehensive Geriatric Assessment (CGA)

2 - Screening by G8 (followed by further assessment if score ≤14) and Mini-COG

3 - Screening by G8 only (followed by further assessment if score ≤14)

4 - Other assessment tools

5 - No

6 - Abstain (including I do not recommend a health status assessment)


Opt Votes

1 7

2 8

3 8

4 4

5 3

6 18

7 4

N 52

Detailed voting

results

26%

29%

30%

15%

Option 1

Option 2

Option 3

Option 4

www.apccc.org




www.apccc.org



If you lived in a country with limited resources available for healthcare, what would you recommend as ADT in the metastatic setting?

0

Global access to prostate cancer drugs and treatment in countries with limited resources

1 - LHRH agonist

2 - LHRH antagonist

3 - Orchiectomy

4 - First generation AR antagonist as single agent

5 - Abstain


Opt Votes

1 5

2 0

3 46

4 0

5 0

6 0

N 51

10%

90%

Option 1

Option 2

Option 3

Option 4

Detailed voting

results

www.apccc.org



What is your preferred treatment choice for second-line endocrine manipulations when Abiraterone and/or Enzalutamide are NOT available?

0


1 - Estramustine

2 - First generation AR antagonist

3 - Ketoconazole

4 - Oestrogens

5 - Steroid monotherapy (e.g. Dexamethasone)

6 - Abstain


Opt Votes

1 2

2 22

3 10

4 4

5 12

6 0

7 0

N 50

4%

44%

20%

8%

24% Option 1

Option 2

Option 3

Option 4

Option 5

Option 6

Detailed voting

results

www.apccc.org



Each of the following drugs is on the WHO essential medicines list and/or you are able to source them at an affordable price from generic manufacturer. Which do you consider to be appropriate treatment options in the setting of limited healthcare resources and in men with mCRPC who are progressing on or after Docetaxel? Platinum (Carboplatin/Cisplatin)

0


1 - Yes

2 - No

3 - Abstain


Opt Votes

1 40

2 10

3 2

4 0

N 52

77%

19%

4%

Option 1

Option 2

Option 3

Detailed voting

results

www.apccc.org



Cyclophosphamide

0


1 - Yes

2 - No

3 - Abstain


Opt Votes

1 20

2 27

3 4

4 1

N 52

39%

53%

8%

Option 1

Option 2

Option 3

Each of the following drugs is on the WHO essential medicines list and/or you are able to source them at an affordable price from generic manufacturer. Which do you consider to be appropriate treatment options in the setting of limited healthcare resources and in men with mCRPC who are progressing on or after Docetaxel?

Detailed voting

results

www.apccc.org



Paclitaxel

0


1 - Yes

2 - No

3 - Abstain


Opt Votes

1 8

2 39

3 3

4 1

N 51

16%

78%

6%

Option 1

Option 2

Option 3


Detailed voting

results

www.apccc.org



Doxorubicin

0


1 - Yes

2 - No

3 - Abstain


Opt Votes

1 6

2 42

3 2

4 1

N 51

12%

84%

4%

Option 1

Option 2

Option 3


Detailed voting

results

www.apccc.org



Mitoxantrone

0


1 - Yes

2 - No

3 - Abstain


Opt Votes

1 35

2 16

3 0

4 0

N 51

69%

31% Option 1

Option 2

Option 3


Detailed voting

results

advanced prostate cancer consensus questions 2017 questions... · 2 - imaging after 6 months...

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