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“Non-metastatic, Castration-resistant Prostate Cancer: Diagnostic and Treatment Recommendations by an Expert Panel from Brazil”

2022; Elsevier BV; Volume: 21; Issue: 2 Linguagem: Inglês

10.1016/j.clgc.2022.09.005

1938-0682

Denis L. Jardim, Carlos Silva, Alexandre Saad Fere Lima Pompeo, Álvaro S. Sarkis, Ana Paula Garcia Cardoso, André Deeke Sasse, André P. Fay, Andrey Soares, Antônio Carlos Lima Pompeo, Ariê Carneiro, Ariel Galapo Kann, Camilla Fogassa, Celso Heitor De Freitas, Daher C. Chade, Daniel Herchenhorn, Daniel Vargas Pivato de Almeida, Diogo Augusto Rodrigues Rosa, Evanius Garcia Wiermann, Fábio Augusto Barros Schütz, Fabio Kater, Fernando De Moura, Fernando Korkes, Fernando Meyer, Fernando Nunes Galvão de Oliveira, Fernando Sabino, Gilberto Laurino Almeida, Guilherme Avanço, Gustavo Cardoso Guimarães, Gustavo Caserta Lemos, Gustavo F. Carvalhal, Hanna Kim, Igor Protzner Morbeck, João Carlos Campagnari, José Augusto Rinck, José Ricardo Tuma da Ponte, Karine Martins da Trindade, Leonardo Atem, Leonardo Luiz Borges, Lucas Nogueira, Lucas Teixeira e Aguiar Batista, Manuel Caitano Maia, Marcus Vinícius Sadi, Maria Alzira Almeida Rocha, Murilo Luz, Òren Smaletz, Paulo Sergio Moraes Lages, Raquel Midori Koga Matuda, Rodolfo Borges dos Reis, Rodrigo Frota Indio, Roni de Carvalho Fernandes, Sandro Roberto de Araújo Cavalléro, Vinícius Carrera Souza, Wilson Busato, Wladimir Alfer, Fernando Cotait Maluf,

Cancer Diagnosis and Treatment

Non-metastatic, castration-resistant prostate cancer (nmCRPC) is an important clinical stage of prostate cancer, prior to morbidity and mortality from clinical metastases. In particular, the introduction of novel androgen-receptor signaling inhibitors (ARSi) has changed the therapeutic landscape in nmCRPC. Given recent developments in this field, we update our recommendations for the management of nmCRPC.A panel of 51 invited medical oncologists and urologists convened in May of 2021 with the aim of discussing and providing recommendations regarding the most relevant issues concerning staging methods, antineoplastic therapy, osteoclast-targeted therapy, and patient follow-up in nmCRPC. Panel members considered the available evidence and their practical experience to address the 73 multiple-choice questions presented.Key recommendations and findings include the reliance on prostate-specific antigen doubling time for treatment decisions, the absence of a clear preference between conventional and novel (i.e., positron-emission tomography-based) imaging techniques, the increasing role of ARSis in various settings, the general view that ARSis have similar efficacy. Panelists highlighted the slight preference for darolutamide, when safety is of greater concern, and a continued need to develop high-level evidence to guide the intensity of follow-up in this subset of prostate cancer.Despite the limitations associated with a consensus panel, the topics addressed are relevant in current practice, and the recommendations can help practicing clinicians to provide state-of-the-art treatment to patients with nmCRPC in Brazil and other countries with similar healthcare settings.