Joung Jae Young, Jeong In Gab, Kang Sung Gu, Ko Young Hwii, Koo Kyo Chul, Kim Kwang Hyun, Kim Myung Ki, Kim Soodong, Kim Jeong Hyun, Park Sung-Woo, Park Jae Young, Song Wan, Lee Seung Hwan, Jung Seung Il, Chung Jae Hoon, Jeong Chang Wook, Joo Kwan Joong, Choi Seock Hwan, Choi Se Young, Choo Seol Ho, Ha Hong Koo, Hong Sung Kyu, Hong Sung-Hoo, Hong Jeong Hee, Hong Jun Hyuk, Kim Sun Il, Kwak Cheol, Jeon Seong Soo
Department of Urology, Urological Cancer Center, National Cancer Center, Goyang, Korea.
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Investig Clin Urol. 2025 Sep;66(5):416-430. doi: 10.4111/icu.20250147.
Consensus is lacking among South Korean urologists on the appropriate treatment of metastatic hormone-sensitive prostate cancer (mHSPC). A modified, Delphi-based consensus on managing mHSPC patients was developed to support clinical decision-making.
Thirty-six questions on mHSPC treatment were developed by an expert committee (five urologists). Nine questions required achievement of consensus (key questions). Twenty-three urologists participated in two rounds of a Delphi survey. Consensus was defined as ≥75% agreement among panelists, with ≥90% agreement representing strong consensus.
Eighteen questions (50.0%) reached strong consensus, 15 (41.7%) reached consensus, and three (8.3%) reached no consensus. Eight key questions (88.9%) reached strong consensus and one (11.1%) reached consensus. Consensus was reached on recommending androgen-deprivation therapy (ADT) intensification, irrespective of disease volume or type, with an androgen receptor pathway inhibitor (ARPI) as the preferred option. Not using docetaxel alone with ADT when an ARPI is available for treatment intensification was recommended (strong consensus). For high-volume mHSPC patients with a pathogenic, speckle-type poxvirus and zinc finger protein mutation, ADT+ARPI was recommended over triplet therapy (strong consensus). Panelists recommended regular imaging every 6-12 months if no ARPI reimbursement restrictions exist, but a 3-month interval (per current reimbursement guidelines) otherwise. ADT+ARPI was the most recommended systemic treatment (strong consensus).
This Delphi consensus established local consensus on controversial areas of mHSPC management. The findings offer meaningful perspectives that may help shape future treatment strategies and encourage thoughtful reconsideration of reimbursement criteria to align evidence and clinical practice in South Korea.
韩国泌尿外科医生对于转移性激素敏感性前列腺癌（mHSPC）的恰当治疗缺乏共识。基于德尔菲法制定了关于mHSPC患者管理的修订共识，以支持临床决策。
由一个专家委员会（五名泌尿外科医生）拟定了36个关于mHSPC治疗的问题。九个问题需要达成共识（关键问题）。23名泌尿外科医生参与了两轮德尔菲调查。共识定义为专家组成员中≥75%的人达成一致，≥90%的人达成一致表示强烈共识。
18个问题（50.0%）达成强烈共识，15个（41.7%）达成共识，3个（8.3%）未达成共识。八个关键问题（88.9%）达成强烈共识，一个（11.1%）达成共识。对于强化雄激素剥夺治疗（ADT）达成了共识，无论疾病体积或类型如何，以雄激素受体通路抑制剂（ARPI）作为首选方案。当有ARPI可用于强化治疗时，建议不要将多西他赛与ADT单独联合使用（强烈共识）。对于有致病性斑点型痘病毒和锌指蛋白突变的高体积mHSPC患者，推荐ADT + ARPI而非三联疗法（强烈共识）。如果不存在ARPI报销限制，专家组成员建议每6 - 12个月进行一次定期成像，否则按照当前报销指南为每3个月一次。ADT + ARPI是最推荐的全身治疗方法（强烈共识）。
该德尔菲共识在mHSPC管理的争议领域建立了本地共识。这些发现提供了有意义的观点，可能有助于塑造未来的治疗策略，并鼓励对报销标准进行深入重新思考，以使韩国的证据与临床实践保持一致。
