Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland.
Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
Eur J Cancer. 2022 Jan;160:24-60. doi: 10.1016/j.ejca.2021.09.036. Epub 2021 Nov 26.
Innovations in treatments, imaging and molecular characterisation have improved outcomes for people with advanced prostate cancer; however, many aspects of clinical management are devoid of high-level evidence. At the Advanced Prostate Cancer Consensus Conference (APCCC) 2019, many of these topics were addressed, and consensus was not always reached. The results from clinical trials will most reliably plus the gaps.
An invited panel of 57 experts voted on 123 multiple-choice questions on clinical management at APCCC 2019. No consensus was reached on 88 (71.5%) questions defined as <75% of panellists voting for the same answer option. We reviewed clinicaltrials.gov to identify relevant ongoing phase III trials in these areas of non-consensus.
A number of ongoing phase III trials were identified that are relevant to these non-consensus issues. However, many non-consensus issues appear not to be addressed by current clinical trials. Of note, no phase III but only phase II trials were identified, investigating side effects of hormonal treatments and their management.
Lack of consensus almost invariably indicates gaps in existing evidence. The high percentage of questions lacking consensus at APCCC 2019 highlights the complexity of advanced prostate cancer care and the need for robust, clinically relevant trials that can fill current gaps with high-level evidence. Our review of these areas of non-consensus and ongoing trials provides a useful summary, indicating areas in which future consensus may soon be reached. This review may facilitate academic investigators to identify and prioritise topics for future research.
治疗方法、成像技术和分子特征的创新提高了晚期前列腺癌患者的治疗效果；然而，许多临床管理方面缺乏高级别的证据。在 2019 年的高级前列腺癌共识会议（APCCC）上，讨论了许多这些话题，但并未达成共识。临床试验的结果将最可靠地填补这些空白。
一个由 57 名专家组成的受邀小组在 2019 年的 APCCC 上对 123 个关于临床管理的多项选择题进行了投票。未达成共识的问题有 88 个（71.5%的小组成员投票选择了相同的答案选项）。我们查阅了 clinicaltrials.gov，以确定这些无共识领域中正在进行的相关 III 期临床试验。
确定了一些与这些无共识问题相关的正在进行的 III 期临床试验。然而，许多无共识问题似乎没有被当前的临床试验所涉及。值得注意的是，没有发现 III 期试验，只有 II 期试验，调查了激素治疗的副作用及其管理。
几乎没有共识总是表明现有证据存在差距。在 2019 年的 APCCC 上，缺乏共识的问题比例很高，这突出了晚期前列腺癌护理的复杂性，以及需要进行强有力的、具有临床相关性的试验，以用高级别的证据填补当前的空白。我们对这些无共识领域和正在进行的试验的审查提供了一个有用的总结，指出了未来可能很快达成共识的领域。该审查可以帮助学术研究人员确定和优先考虑未来研究的主题。
