Expert Perspectives on Controversies in Castration-Sensitive Prostate Cancer Management: Narrative Review and Report...

Area of Science:

• Oncology
• Urology

Background:

• Castration-sensitive prostate cancer (CSPC) presents complex clinical challenges with evolving management strategies.
• Clinicians face numerous questions regarding the optimal, individualized treatment of CSPC due to diverse options.

Purpose of the Study:

• To address controversies and uncertainties in prostate cancer management.
• To identify areas of expert agreement and disagreement on CSPC treatment.

Main Methods:

• Convened a multidisciplinary panel at the US Prostate Cancer Conference (USPCC).
• Experts in urology, medical oncology, radiation oncology, and nuclear medicine participated.
• Sessions focused on key areas of controversy, with expert Q&A to identify consensus and divergence.

Main Results:

• Endorsed gene expression classifiers and artificial intelligence (AI) for risk stratification and treatment selection.
• Recommended advanced imaging for specific patient groups, including those with localized unfavorable disease or biochemical recurrence.
• Supported doublet or triplet therapy for metastatic CSPC (mCSPC) and considered radiation therapy for select mCSPC patients.

Conclusions:

• CSPC is a heterogeneous disease requiring careful management to avoid undertreatment or overtreatment.
• Further validation and clinical integration of novel technologies like genomics, AI, and advanced imaging are crucial for optimizing CSPC patient outcomes.