St. Gallen consensus conference on treatment of advanced prostate cancer


Apparently, early in 2015, there was a major international consensus conference, among nearly 50 of the leading international authorities, on the treatment of advanced prostate cancer.

The detailed findings of the expert panel (reported by Gillessen et al.) were first published in the Annals of Oncology in June 2015 and are available in full on line. They will make interesting reading for many patients and support group leaders, who may also not have been aware of this meeting and its report. (It wasn’t exactly widely publicized.) What are also of interest are some of the detailed findings of the expert panel, reported in two of the study appendices:

While it would be impossible here to go through all of the findings of this international panel, some of the findings will very definitely be of interest to many readers. For example:

In patients with metastatic prostate cancer achieving an adequate PSA decline (confirmed PSA fall below 4 ng/ml after about 6 months of ADT), 71% of the panellists recommended intermittent instead of continuous ADT only for a minority of selected patients.

However,

In a clear consensus, 94% of the panellists would discuss the option of intermittent ADT in metastatic patients, 54% in the majority of patients and 40% in a minority of selected patients who achieved an adequate PSA decline.

In other words, not only are there still some major differences of opinion among these experts about the role of intermittent androgen deprivation therapy, we find it interesting that the bar they set for an “adequate” PSA decline prior to initiation of ADT was only 4 ng/ml, whereas many experienced patients consider that a patient’s PSA needs to drop to < 0.1 ng/ml on an initial 6 to 9 months of ADT before they would be considered a good candidate for intermittent ADT. On the other hand, 94 percent of the experts would be willing to let the patient make the decision about initiation of ADT in at least a minority of patients.

On a more controversial question — the use or non-use of combined androgen deprivation therapy (ADT) with an LHRH agonist and an antiandrogen as opposed to single agent ADT with an LHRH agonist (or antagonist) alone, the expert panel seems to have been completely split:

Half of the panel did not recommend CAB whereas 35% recommended it in a minority of selected patients and 15% recommended it in the majority of patients.

A place where there seems to have been a great deal of consensus, however, was with regard to the non-use of drugs like zoledronic acid and denosumab in men with castration-naive (“hormone-naive”), metastatic prostate cancer (unless, perhaps, this was justified by clear evidence of existing osteoporosis):

There was consensus amongst panellists that patients with castration-naïve prostate cancer and bone metastases should not receive zoledronic acid (81% of the panel) or denosumab (79% of the panel)for reducing risk of SREs.

It appears that an expert panel is scheduled to gather again at St. Gallen in early 2017 to revisit many of these questions (in particular the more controversial ones). Clearly we shall need to be paying more attention to look out for their report in about 18 months time.

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