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Advanced Prostate Cancer Consensus Conference (APCCC) 2015 in St. Gallen

Kritische Betrachtung der Empfehlungen zur Diagnostik und Therapie des metastasierten Prostatakarzinoms durch ein deutsches Expertengremium

Advanced Prostate Cancer Consensus Conference (APCCC) 2015 in St. Gallen

Critical review of the recommendations on diagnosis and therapy of metastatic prostate cancer by a German expert panel

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Zusammenfassung

Im März 2015 fand erstmalig die Advanced Prostate Cancer Consensus Conference (APCCC) in St. Gallen statt. Kontroversen rund um das fortgeschrittene Prostatakarzinom wurden von 41 Experten aus 17 Ländern diskutiert mit dem Ziel, Konsensusempfehlungen auszusprechen. Die Ergebnisse wurden aktuell in der Fachzeitschrift „Annals of Oncology“ publiziert. Obwohl ein Großteil der in St. Gallen ausgesprochenen Empfehlungen nachvollziehbar ist, sind einige Stellungnahmen kritisch zu betrachten. Als deutsches Expertengremium nehmen wir hierzu Stellung. Im hormonnaiven metastasierten Stadium sollte die kontinuierliche Androgendeprivation (ADT) als Standard gesehen werden. Für eine Überlegenheit der primär maximalen Androgenblockade gibt es keine Evidenz. Nach aktueller Datenlage sollte Patienten mit gutem Allgemeinzustand, insbesondere bei hoher Tumorlast, eine Kombinationstherapie aus ADT plus Taxanen angeboten werden. Im metastasierten kastrationsresistenten Stadium ist als Erstlinientherapie eine Hormonmanipulation mit neuartigen endokrinen Medikamenten Therapie der Wahl in der Mehrheit der Patienten. Taxane haben eine primäre Indikation bei ungünstigen Prognoseparametern. Radium-223 ist eine Option bei ossärer Metastasierung. Von einer nochmaligen Hormonmanipulation nach Versagen von Abirateron oder Enzalutamid in der Erstlinie sollte wenn möglich Abstand genommen werden. Bei Patienten mit gutem Allgemeinzustand sollte Cabazitaxel einen festen Stellenwert in der Sequenztherapie haben. Für das initiale Staging im kastrationsresistenten Stadium ist ein CT-Abdomen/-Thorax plus Knochenszintigramm empfehlenswert. Eine erneute Bildgebung empfiehlt sich bei Tumorprogress, ansonsten alle 4–6 Monate. Bezüglich der Biomarker sollte eine Bestimmung von Serum-PSA und AP alle 2–4 Monate erfolgen.

Abstract

In March 2015, the first Advanced Prostate Cancer Consensus Conference (APCC) took place in St. Gallen. 41 experts from 17 countries reviewed important areas of controversy in advanced hormone-naive and castration-resistant prostate cancer and gave therapy recommendations. These results have been recently published in “Annals of Oncology”. While most of the recommendations from St. Gallen are comprehensible, some of them need to be further discussed. Therefore, we as a German expert panel will critically debate the St. Gallen recommendations. For metastatic hormone-naive prostate cancer, continuous androgen deprivation remains the standard. There is no evidence for superiority of primary maximal androgen deprivation. Patients suitable for chemotherapy, especially in the presence of high tumour burden, should receive androgen deprivation plus taxanes upfront. In metastatic castration resistant prostate cancer, novel hormonal agents like abiraterone or enzalutamid should be the treatment of choice in the majority of patients. Taxanes should be used first-line in patients with unfavourable prognostic markers. Radium-223 is an option in symptomatic patients with bone metastases. There is first evidence that second-line hormonal treatment after first-line failure of a novel endocrine agent has a high failure rate. Cabazitaxel should be part of the treatment sequence in patients with a good performance status. Baseline staging for castration-resistant prostate cancer should include CT-abdomen/-chest and bone scan. Radiographic monitoring should be performed 2 to 3 times a year. Determination of PSA and ALP is to take place every 2 to 4 months.

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Author information

Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland

    C. Thomas

  2. Klinik für Urologie, Universitätsklinikum Münster, Münster, Deutschland

    M. Bögemann

  3. ATURO, Facharztzentrum für Urologie, Berlin, Deutschland

    F. König

  4. Klinik für Urologie, Marien-Krankenhaus Bergisch Gladbach, Bergisch Gladbach, Deutschland

    S. Machtens

  5. Klinik für Urologie und Kinderurologie, Uniklinik Magdeburg, Magdeburg, Deutschland

    M. Schostak

  6. Martini Klinik, Hamburg, Deutschland

    T. Steuber

  7. Klinik und Poliklinik für Urologie, Universitätsklinikum Köln, Köln, Deutschland

    A. Heidenreich

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Correspondence to C. Thomas.

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Interessenkonflikt

C. Thomas, M. Bögemann, F. König, S. Machtens, M. Schostak, T. Steuber und A. Heidenreich geben an, dass kein Interessenkonflikt besteht.

Das Positionspapier basiert auf einem Expertenmeeting, das von der Firma Sanofi finanziert und organisiert wurde. Die Firma hatte keinen Einfluss auf die Inhalte des Manuskriptes.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Thomas, C., Bögemann, M., König, F. et al. Advanced Prostate Cancer Consensus Conference (APCCC) 2015 in St. Gallen . Urologe 55, 772–782 (2016). https://doi.org/10.1007/s00120-016-0030-8

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