Lack of consensus identifies important areas for future clinical research: Advanced Prostate Cancer Consensus Conference (APCCC) 2019 findings

Vogl, Ursula M.; Beer, Tomasz M.; Davis, Ian D.; Shore, Neal D.; Sweeney, Christopher J.; Ost, Piet; Attard, Gerhardt; Bossi, Alberto; de Bono, Johann; Drake, Charles G.; Efstathiou, Eleni; Fanti, Stefano; Fizazi, Karim; Halabi, Susan; James, Nicolas; Mottet, Nicolas; Padhani, Anwar R.; Roach, Mack; Rubin, Mark; Sartor, Oliver; ... (2022). Lack of consensus identifies important areas for future clinical research: Advanced Prostate Cancer Consensus Conference (APCCC) 2019 findings. European journal of cancer, 160, pp. 24-60. Elsevier 10.1016/j.ejca.2021.09.036

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Background:Innovations in treatments, imaging and molecular characterisationhave improved outcomes for people with advanced prostate cancer; however, many aspectsof clinical management are devoid of high-level evidence. At the Advanced Prostate CancerConsensus Conference (APCCC) 2019, many of these topics were addressed, and consensuswas not always reached. The results from clinical trials will most reliably plus the gaps.Methods:An invited panel of 57 experts voted on 123 multiple-choice questions on clinicalmanagement at APCCC 2019. No consensus was reached on 88 (71.5%) questions definedas<75% of panellists voting for the same answer option. We reviewed clinicaltrials.gov toidentify relevant ongoing phase III trials in these areas of non-consensus.Results: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 currentclinical trials. Of note, no phase III but only phase II trials were identified, investigating sideeffects of hormonal treatments and their management.Conclusions:Lack of consensus almost invariably indicates gaps in existing evidence. The highpercentage of questions lacking consensus at APCCC 2019 highlights the complexity ofadvanced prostate cancer care and the need for robust, clinically relevant trials that can fillcurrent gaps with high-level evidence. Our review of these areas of non-consensus and ongoingtrials provides a useful summary, indicating areas in which future consensus may soon bereached. This review may facilitate academic investigators to identify and prioritise topicsfor future research.

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