Abstract
Most prostate cancer patients who undergo androgen-deprivation therapy or orchiectomy will eventually develop castration-resistant prostate cancer (CRPC), often preceded by a nonmetastatic CRPC state known as M0CRPC. The recent development of second-generation antiandrogens provides clinicians with efficacious and safe treatments for M0CRPC. However, the complexity of these patients, who typically have to deal with underlying comorbidities and polypharmacy, often challenges therapeutic decisions in this setting. The recent development of novel imaging techniques also provides clinicians with tools for detecting metastases with high sensitivity and specificity. However, the lack of evidence on the early detection of metastases and the corresponding impact on therapeutic decisions makes these techniques a double-edged sword that must be managed appropriately. Here, we present the expert view of the rapidly evolving concept of M0CRPC and provide recommendations for the identification of these patients, the appropriate use of the emerging imaging modalities, and patients’ management, particularly considering their clinical complexity and the recent development of next-generation antiandrogens.
Highlights
Prostate cancer is the second most frequently diagnosed cancer in men, accounting for 15% of all cancers diagnosed worldwide [1]
Many patients will experience a disease state known as nonmetastatic castration-resistant prostate cancer (CRPC) or M0CRPC state, defined by rising PSA levels despite castrate levels of testosterone and absence of detectable metastases on conventional imaging techniques [4]
We present the expert view of the rapidly evolving concept of M0CRPC and provide recommendations for the identification of these patients, the appropriate use of the emerging imaging modalities, and patients’ management, considering their clinical complexity and the recent development of next-generation antiandrogens. e recommendations presented are based on a thorough review of the literature and the conclusions drawn by the authors from two consecutive focus group discussion
Summary
Prostate cancer is the second most frequently diagnosed cancer in men, accounting for 15% of all cancers diagnosed worldwide [1]. We present the expert view of the rapidly evolving concept of M0CRPC and provide recommendations for the identification of these patients, the appropriate use of the emerging imaging modalities, and patients’ management, considering their clinical complexity and the recent development of next-generation antiandrogens. E first meeting, held on July 03, 2020, was aimed at identifying the main topics to be addressed regarding the routine practice of patients with nmCRPC Based on this list of contents, a state-of-art document that summarized the available information in the literature was prepared and distributed among experts. Held on September 10, 2020, the experts discussed and agreed on the list of recommendations regarding the preselected topics, which were based on the literature evidence and their experience in routine practice. Held on September 10, 2020, the experts discussed and agreed on the list of recommendations regarding the preselected topics, which were based on the literature evidence and their experience in routine practice. e output of the second meeting, alongside the state-of-art of nmCRPC, was used to prepare a first manuscript draft, which was subsequently revised by all co-authors
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