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      Management of patients with advanced prostate cancer: recommendations of the St Gallen Advanced Prostate Cancer Consensus Conference (APCCC) 2015

      1 , * , 1 , 2 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 20 , 28 , 29 , 3 , 4 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 14 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48

      Annals of Oncology

      Oxford University Press

      advanced prostate cancer, castration-resistant prostate cancer, therapeutics, consensus, castration-naïve prostate cancer

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          The first St Gallen Advanced Prostate Cancer Consensus Conference (APCCC) Expert Panel identified and reviewed available evidence for the ten most important areas of controversy in advanced prostate cancer management. Recommendations based on expert opinion are presented. Detailed decisions on treatment will involve clinical consideration of disease extent and location, prior treatments, host factors, patient preferences and logistical and economic constraints.


          The first St Gallen Advanced Prostate Cancer Consensus Conference (APCCC) Expert Panel identified and reviewed the available evidence for the ten most important areas of controversy in advanced prostate cancer (APC) management. The successful registration of several drugs for castration-resistant prostate cancer and the recent studies of chemo-hormonal therapy in men with castration-naïve prostate cancer have led to considerable uncertainty as to the best treatment choices, sequence of treatment options and appropriate patient selection. Management recommendations based on expert opinion, and not based on a critical review of the available evidence, are presented. The various recommendations carried differing degrees of support, as reflected in the wording of the article text and in the detailed voting results recorded in supplementary Material, available at Annals of Oncology online . Detailed decisions on treatment as always will involve consideration of disease extent and location, prior treatments, host factors, patient preferences as well as logistical and economic constraints. Inclusion of men with APC in clinical trials should be encouraged.

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          Most cited references 57

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          Aggressive variants of castration-resistant prostate cancer.

          A subset of patients with advanced castration-resistant prostate cancer may eventually evolve into an androgen receptor (AR)-independent phenotype, with a clinical picture associated with the development of rapidly progressive disease involving visceral sites and hormone refractoriness, often in the setting of a low or modestly rising serum prostate-specific antigen level. Biopsies performed in such patients may vary, ranging from poorly differentiated carcinomas to mixed adenocarcinoma-small cell carcinomas to pure small cell carcinomas. These aggressive tumors often demonstrate low or absent AR protein expression and, in some cases, express markers of neuroendocrine differentiation. Because tumor morphology is not always predicted by clinical behavior, the terms "anaplastic prostate cancer" or "neuroendocrine prostate cancer" have been used descriptively to describe these rapidly growing clinical features. Patients meeting clinical criteria of anaplastic prostate cancer have been shown to predict for poor prognosis, and these patients may be considered for platinum-based chemotherapy treatment regimens. Therefore, understanding variants within the spectrum of advanced prostate cancer has important diagnostic and treatment implications. ©2014 American Association for Cancer Research.
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            The efficacy and safety of degarelix: a 12-month, comparative, randomized, open-label, parallel-group phase III study in patients with prostate cancer.

            To evaluate the efficacy and safety of degarelix, a new gonadotrophin-releasing hormone (GnRH) antagonist (blocker), vs leuprolide for achieving and maintaining testosterone suppression in a 1-year phase III trial involving patients with prostate cancer. In all, 610 patients with adenocarcinoma of the prostate (any stage; median age 72 years; median testosterone 3.93 ng/mL, median prostate-specific antigen, PSA, level 19.0 ng/mL) were randomized and received study treatment. Androgen-deprivation therapy was indicated (neoadjuvant hormonal treatment was excluded) according to the investigator's assessment. Three dosing regimens were evaluated: a starting dose of 240 mg of degarelix subcutaneous (s.c.) for 1 month, followed by s.c. maintenance doses of 80 mg or 160 mg monthly, or intramuscular (i.m.) leuprolide doses of 7.5 mg monthly. Therapy was maintained for the 12-month study. Both the intent-to-treat (ITT) and per protocol populations were analysed. The primary endpoint of the trial was suppression of testosterone to
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              Metastasis-directed therapy of regional and distant recurrences after curative treatment of prostate cancer: a systematic review of the literature.

              The introduction of novel imaging modalities has increased the detection of oligometastatic prostate cancer (PCa) recurrence, potentially justifying the use of a metastasis-directed therapy (MDT) with surgery or radiotherapy (RT) rather than a systemic approach.

                Author and article information

                Ann Oncol
                Ann. Oncol
                Annals of Oncology
                Oxford University Press
                August 2015
                03 June 2015
                03 June 2015
                : 26
                : 8
                : 1589-1604
                [1 ]Department of Oncology/Haematology, Kantonsspital St Gallen , St Gallen, Switzerland
                [2 ]Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research , Sutton, UK
                [3 ]Department of Genitourinary Medical Oncology, MD Anderson Cancer Centre , Houston
                [4 ]Department of Genitourinary Medical Oncology, David H. Koch Centre, The University of Texas M. D. Anderson Cancer Centre , Houston, USA
                [5 ]Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School , Athens, Greece
                [6 ]Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Sud , Villejuif, France
                [7 ]Department of Biostatistics and Bioinformatics, Duke University , Durham
                [8 ]Division of Human Biology, Fred Hutchinson Cancer Research Centre , Seattle
                [9 ]Tulane Cancer Centre, Tulane University , New Orleans
                [10 ]Massachusetts General Hospital Cancer Centre , Boston
                [11 ]Prostate Cancer Foundation , Santa Monica, USA
                [12 ]Research Centre for Advanced Science and Technology, The University of Tokyo , Tokyo, Japan
                [13 ]Oregon Health & Science University Knight Cancer Institute , Portland
                [14 ]Department of Medicine, Weill Cornell Medical College , New York
                [15 ]Michigan Centre for Translational Pathology, Department of Pathology
                [16 ]Department of Urology, Comprehensive Cancer Centre
                [17 ]Howard Hughes Medical Institute, University of Michigan Medical School , Ann Arbor, USA
                [18 ]Department of Oncology, Copenhagen University Hospital, Rigshospitalet , Copenhagen, Denmark
                [19 ]Monash University and Eastern Health, Eastern Health Clinical School , Box Hill, Australia
                [20 ]Cancer Research Centre, University of Warwick , Warwick, UK
                [21 ]Ludwig Boltzmann Institute for Applied Cancer Research, Kaiser Franz Josef-Spital , Vienna, Austria
                [22 ]Johns Hopkins Sidney Kimmel Cancer Center and The Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine , Baltimore, USA
                [23 ]The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust , London, UK
                [24 ]Department of Nuclear Medicine, Policlinico S. Orsola, University of Bologna , Bologna, Italy
                [25 ]Urological Sciences, Vancouver Prostate Centre, University of British Columbia , Vancouver, Canada
                [26 ]Klinik und Poliklinik für Urologie, RWTH University Aachen , Aachen, Germany
                [27 ]University of Michigan Comprehensive Cancer Center , Ann Arbor, USA
                [28 ]Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham , Birmingham, UK
                [29 ]Department of Radiology, Centre du Cancer et Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc , Brussels, Belgium
                [30 ]Europa Uomo Prostate Patients , Clayhall Ilford, UK
                [31 ]Department of Oncology-Pathology, Karolinska Institutet , Stockholm, Sweden
                [32 ]Division of Haematology and Medical Oncology, The Tisch Cancer Institute , Icahn School of Medicine at Mount Sinai , New York, USA
                [33 ]Prostate Cancer Clinical Research Unit, Spanish National Cancer Research Centre (CNIO) , Madrid
                [34 ]CNIO-IBIMA Genitourinary Cancer Unit, Hospitales Universitarios Virgen de la Victoria y Regional de Málaga, Málaga
                [35 ]Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain
                [36 ]Paul Strickland Scanner Centre, Mount Vernon Cancer Centre , Northwood
                [37 ]Prostate Cancer Targeted Therapy Group, Academic Urology Unit and Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research , Sutton, UK
                [38 ]Institute for Precision Medicine, Meyer Cancer Center, Department of Pathology and Urology, Weill Cornell Medical College and NewYork Presbyterian , New York, USA
                [39 ]Department of Urology, Radboud University, Medical Centre , Nijmegen, The Netherlands
                [40 ]Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Centre , New York
                [41 ]Department of Oncology, Assaf Harofeh Medical Centre, Tel-Aviv University, Sackler School of Medicine , Zerifin, Israel
                [42 ]Department of Urology, Carolina Urologic Research Centre , Myrtle Beach
                [43 ]Helen Diller Family Comprehensive Cancer Centre, UCSF , San Francisco, USA
                [44 ]Department of Medical Oncology, San Camillo and Forlanini Hospitals , Rome, Italy
                [45 ]Department of Urology, Toho University Sakura Medical Center , Chiba, Japan
                [46 ]Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital , Harvard Medical School , Boston, USA
                [47 ]Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre , Toronto, Canada
                [48 ]Service D'Urologie, Institut de Recherche Clinique, Université Catholique de Louvain , Brussels, Belgium
                Author notes
                [* ] Correspondence to: Dr Silke Gillessen, Department of Oncology/Haematology, Kantonsspital St Gallen, Rorschacherstrasse 95, 9007 St Gallen, Switzerland. E-mail: silke.gillessen@ 123456kssg.ch

                Both are joint first authors.


                Both are joint last authors.

                © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                Funded by: Cantonal Hospital St Gallen
                Funded by: City and Canton of St Gallen
                Funded by: Swiss Cancer Research Organisation
                Funded by: European School of Oncology (ESO)
                Funded by: Swiss Cancer League
                Funded by: Swiss Oncology Research Network SAKK
                Funded by: Swiss Cancer Foundation
                Funded by: Prostate Cancer Foundation http://dx.doi.org/10.13039/100000892
                Funded by: Günter and Regine Kelm Foundation
                Funded by: Movember Foundation http://dx.doi.org/10.13039/100008719
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