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EAU and APCCC session: A focus on mHSPC

Chairs Prof. Nicolas Mottet (FR) and Prof. Christopher Sweeney (US) spearheaded the EAU Specialty Session “Joint session of the EAU and the Advanced Prostate Cancer Consensus (APCCC)”. The session kickstarted with a patient case on de novo high-volume elderly patient which was presented by Dr. Fabio Turco (CH). Unfortunately due to COVID-19, presenters Prof. Anwar Padhani (GB) and Dr. Giulia Baciarello (IT) were not able to present onsite but were able provide pre-recorded lectures for the session.

During “Ideal imaging in this setting”, Prof. Padhani stated that CT and bone scan for metastatic hormone-sensitive prostate cancer (mHSPC) are convenient, affordable, and widely available with an established base of skilled users. He added that rMFS and rFPS are acceptable surrogates for the overall survival (OS) of multiple advanced prostate cancer states. Furthermore, he said that there are few indications for the primary use of next-generation imaging in mHSPC.

In the lecture “Adding an AR-targeted drug alone to ADT”, Dr. Giulia Baciarello (IT) shared that chronological and biological ages are different. “Men who are older than 70-years old should be treated according to their health status. ARPIs (androgen receptor pathway inhibitors) showed an OS benefit in elderly population. Fit patients should be treated with combination therapies,” said Dr. Baciarello. She added that geriatric assessment is mandatory for vulnerable patients; majority should still be considered for standard (adapted) treatments.

During “Optimal treatment for high volume de novo patients who are elderly” by Prof. Christopher Sweeney (US), he stated that “For patients with poor prognosis of three years of ADT (androgen deprivation therapy) alone, with four or more bone metastases and/or visceral metastases, if they’re chemofit, I propose trying abiraterone, darolutamide, enzalutamide plus docetaxel. If the patients are not candidates for docetaxel, I propose abiraterone, enzalutamide, and apalutamide.”

Prof. Sweeney added that the treatment is not something that has to be done on day one, but already starting the hormonal therapy would be beneficial for the patient. Prof. Sweeney advised involving the patient in the treatment choice. He explained, “If a patient is chemofit, it is best to give the treatment at his strongest because he will get frailer over time and provide supportive care and geriatric support.”

Furthermore, if the patient is frail and not chemofit, he advised to provide maximised supportive care, as well as geriatric support in terms of drug rationalisation, physical therapy, and nutrition.

(Re)watch full presentations via EAU22 On Demand on the Virtual Platform.