APCCC: Expert consensus on advanced PCa
Prof. Silke Gillessen Sommer (CH) and Prof. Bertrand Tombal (BE) chaired the Thematic Session ‘Advanced Prostate Cancer Consensus Conference (APCCC) meets EAU’. The session began with an introduction to the APCCC, followed by case presentations and multidisciplinary discussion.
Prof. Gillessen began by explaining the rationale behind establishing the consensus conference for advanced prostate cancer. She highlighted that several topics lacked sufficient evidence, had conflicting findings, or were based on data from selective populations or had varying interpretations.
Prof. Gillessen: “The idea is to bring experience from international experts to less specialised clinicians around the world.” She emphasised that the consensus paper does not provide formal guidelines, but rather expert recommendations for areas with limited, conflicting, or divergent evidence.
The 2024 APCCC publication has 8 chapters of interest and is open access to everyone. You can access it on Europeanurology.com for free.
Case presentation – PCa cT3b N0 M0 ISUP Grade group 5
One of the two cases presented from Assoc. Prof. Peter Chui (HK) was a high-risk 66-year old male patient with localised PCa cT3b N0 M0 ISUP Grade group 5. This followed a multi-disciplinary discussion to review the best treatment options, including radical prostatectomy + extended pelvic lymph node dissection, radical radiotherapy with neoadjuvant and adjuvant androgen deprivation therapy (ADT), or other systemic treatment.
Dr. Aurelius Omlin (CH) firstly shared the APCCC 2024 results for a case such as this. His presentation followed with a urologist’s perspective from Prof. Alberto Briganti (IT). “Surgery is an option for icT3b disease – there is no formal comparative study with RT + ADT +/- abi. Intensification is not always needed; surgery can be followed by tailored approaches. It’s important to note that there is no one-treatment-fits-all approach.”
A radiation oncologist’s perspective on the best treatment option was given by Prof. Piet Ost (BE): “Pelvic RT improves outcomes for PSMA negative selected high-risk patients; Long duration ADT improves outcomes over short duration; and combination of ADT + ARTA improves outcomes for combination of HR factors.”
And lastly, Dr. Ursula Vogl presented a medical oncologist’s perspective. “Look at the clinical relevance of cT2 or cT3 in STAMPEDE criteria when evaluating the addition of 2 years of abiraterone to long term ADT and curative radiotherapy. It is important to have baseline information when starting ADT +/- APRI in case of treatment suspension to evaluation testosterone recovery to baseline levels.”
For treatment, Dr. Vogl suggested the addition of 2 years of abiraterone to 3 years of ADT in patients undergoing curative radiotherapy for high-risk/locally advanced PCa. This was in line with the STAMPEDE criteria and is the standard of care from the EAU Guidelines (strong recommendation). She added, “But careful patient selection is crucial. 2 years of abiraterone and 3 years of ADT needs a fit and compliant patient well screened for potential short and long-term toxicity from treatment intensification.” She also highlighted the importance of preventative measures to consider for treatment-related toxicity, particularly effects on bone health, cardiovascular risks, and metabolic complications.
You can watch the full webcast via the EAU25 Resource Centre.