Non-metastatic, Castration-resistant Prostate Cancer: Diagnostic and Treatment Recommendations by an Expert Panel from Brazil

• Published in: Clinical genitourinary cancer 2023-04, Vol.21 (2), p.e58-e69
• Main Authors: Jardim, Denis L., Gonçalves e Silva, Adriano, Pompeo, Alexandre Saad Fere Lima, Sarkis, Alvaro Sadek, Cardoso, Ana Paula Garcia, Sasse, Andre Deeke, Fay, Andre Poisl, Soares, Andrey, Pompeo, Antonio Carlos Lima, Carneiro, Arie, Kann, Ariel Galapo, Fogassa, Camilla, De Freitas, Celso Heitor, Chade, Daher Cezar, Herchenhorn, Daniel, De Almeida, Daniel Vargas Pivato, Da Rosa, Diogo Augusto Rodrigues, Wiermann, Evanius Garcia, Schutz, Fabio Augusto Barros, Kater, Fabio Roberto, De Moura, Fernando, Korkes, Fernando, Meyer, Fernando, De Oliveira, Fernando Nunes Galvao, Sabino, Fernando, Almeida, Gilberto Laurino, Avanço, Guilherme, Guimaraes, Gustavo Cardoso, Lemos, Gustavo Caserta, Carvalhal, Gustavo Franco, Kim, Hanna, Morbeck, Igor Protzner, Campagnari, Joao Carlos, Rinck, Jose Augusto, Da Ponte, José Ricardo Tuma, Da Trindade, Karine Martins, Atem, Leonardo, Borges, Leonardo, Nogueira, Lucas Mendes, Batista, Lucas Teixeira e Aguiar, Maia, Manuel Caitano, Sadi, Marcus Vinicius, Rocha, Maria Alzira Almeida, Luz, Murilo De Almeida, Smaletz, Oren, Lages, Paulo Sergio Moraes, Matuda, Raquel Midori Koga, Reis, Rodolfo Borges Dos, Indio, Rodrigo Frota, Fernandes, Roni De Carvalho, Cavallero, Sandro Roberto, Souza, Vinicius Carrera, Busato, Wilson, Alfer, Wladimir, Maluf, Fernando
• Format: Article
• Language: English
• Subjects: Androgen Antagonists - therapeutic use; Androgen-receptor signalling inhibitors; Antineoplastic Agents - therapeutic use; Brazil; Castration-resistant prostate cancer; Humans; Male; Non-metastatic; Practice guidelines; Prostate cancer; Prostatic Neoplasms, Castration-Resistant - diagnosis; Prostatic Neoplasms, Castration-Resistant - drug therapy
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2022.09.005

Non-metastatic, castration-resistant prostate cancer (nmCRPC) is an important clinical stage of prostate cancer, prior to morbidity and mortality from clinical metastases. In particular, the introduction of novel androgen-receptor signaling inhibitors (ARSi) has changed the therapeutic landscape in nmCRPC. Given recent developments in this field, we update our recommendations for the management of nmCRPC. A panel of 51 invited medical oncologists and urologists convened in May of 2021 with the aim of discussing and providing recommendations regarding the most relevant issues concerning staging methods, antineoplastic therapy, osteoclast-targeted therapy, and patient follow-up in nmCRPC. Panel members considered the available evidence and their practical experience to address the 73 multiple-choice questions presented. Key recommendations and findings include the reliance on prostate-specific antigen doubling time for treatment decisions, the absence of a clear preference between conventional and novel (i.e., positron-emission tomography-based) imaging techniques, the increasing role of ARSis in various settings, the general view that ARSis have similar efficacy. Panelists highlighted the slight preference for darolutamide, when safety is of greater concern, and a continued need to develop high-level evidence to guide the intensity of follow-up in this subset of prostate cancer. Despite the limitations associated with a consensus panel, the topics addressed are relevant in current practice, and the recommendations can help practicing clinicians to provide state-of-the-art treatment to patients with nmCRPC in Brazil and other countries with similar healthcare settings. A panel of Brazilian experts convened in order to provide recommendations regarding staging methods, antineoplastic therapy, osteoclast-targeted therapy, and patient follow-up in non-metastatic, castration-resistant prostate cancer. Key points include the reliance on prostate-specific antigen doubling time for treatment decisions, the absence of a clear preference between conventional and novel imaging techniques, and the increasing role of novel androgen-receptor signaling inhibitors.