Consensus for Treatment of Metastatic Castration-Sensitive Prostate Cancer: Report From the First Global Prostate Cancer Consensus Conference for Developing Countries (PCCCDC)

Abstract

PURPOSE International guideline recommendations may not always be extrapolated to developing countries where access to resources is limited. In metastatic castration-sensitive prostate cancer (mCSPC), there have been successful drug and imaging advancements that were addressed in the Prostate Cancer Consensus Conference for Developing Countries for best-practice and limited-resource scenarios. METHODS A total of 24 out of 300 questions addressed staging, treatment, and follow-up for patients with mCSPC both in best-practice settings and resource-limited settings. Responses were compiled and presented in percentage of clinicians supporting each response. Questions had 4-8 options for response. RESULTS Recommendations for staging in mCSPC were split but there was consensus that chest x-ray, abdominal and pelvic computed tomography, and bone scan should be used where resources are limited. In both de novo and relapsed low-volume mCSPC, orchiectomy alone in limited resources was favored and in relapsed high-volume disease, androgen deprivation therapy plus docetaxel in limited resources and androgen deprivation therapy plus abiraterone in high-resource settings were consensus. A 3-weekly regimen of docetaxel was consensus among voters. When using abiraterone, a regimen of 1,000 mg plus prednisone 5 mg/d is optimal, but in limited-resource settings, half the panel agreed that abiraterone 250 mg with fatty foods plus prednisone 5 mg/d is acceptable. The panel recommended against the use of osteoclast-targeted therapy to prevent osseous complications. There was consensus that monitoring of patients undergoing systemic treatment should only be conducted in case of prostate-specific antigen elevation or progression-suggestive symptoms. CONCLUSION The treatment recommendations for most topics addressed differed between the best-practice setting and resource-limited setting, accentuating the need for high-quality evidence that contemplates the effect of limited resources on the management of mCSPC.

Promising Therapeutic Activity of 177Lu-PSMA-617 in Synchronous High-Volume Metastatic Hormone-Sensitive Prostate Cancer

“…All patients underwent concomitant ADT/orchiectomy with/without first-generation antiandrogens. Patients also received calcium and vitamin D3 supplementation, and bisphosphonates or denosumab as per guidelines 19 …”

“…Patients also received calcium and vitamin D3 supplementation, and bisphosphonates or denosumab as per guidelines. 19…”

Radiotheranostics in oncology: Making precision medicine possible

“…It was estimated that only about one-half of patients with cancer in the United States could be cured with existing therapies, and the remaining one-half were expected to die of their disease. 22,23 Metastasis often characterizes the late stage of incurable cancer, and it will be useful if, for instance, de novo metastatic castration-sensitive prostate cancer (mCRPC) with a 29.8% survival rate, 24 as well as prostate cancers that progress during or after androgendeprivation therapy (all termed mCRPC), could be equally treated regardless of alterations, such as amplification or mutations in the AR gene characteristic of mCRPC. 25 Regarding hematologic malignancies, radiolabeled antibodies targeting CD20 have been used as therapy for lymphomas: 90 Y-labeled ibritumomab tiuxetan (Zevalin) or 131 I-labeled tositumomab (Bexxar; GlaxoSmithKline).…”

Recent Advances in the Management of Metastatic Prostate Cancer

“…Access to newly approved NHTs as well as genetic testing will face barriers with regards to utilization in low- and middle-income countries both because of their exorbitant price as well as poor medical coverage. 47 Therefore, there needs to be a coordinated effort between various stakeholders including clinicians, pharmaceutical companies, government health agencies, patient advocacy groups, and oncology societies or cooperative groups to mitigate regulatory, financial, and cultural barriers with regards to access to these life-prolonging therapies. In this context, abiraterone 250 mg/day following a low-fat breakfast can be an alternative to the standard 1,000 mg/day abiraterone dose, which can reduce financial toxicity.…”