SOGUG Multidisciplinary Expert Panel Consensus on Updated Diagnosis and Characterization of Prostate Cancer Patients

TL;DR

Experts in prostate cancer care reviewed updated diagnostic and treatment approaches, emphasizing multidisciplinary teamwork and new imaging techniques.

Contribution

The paper provides a multidisciplinary consensus on updated diagnostic and treatment strategies for prostate cancer, emphasizing shared decision-making and new imaging technologies.

Findings

Multidisciplinary team approaches are essential for evidence-based prostate cancer care.

Next-generation imaging techniques like PSMA PET/CT show high sensitivity in prostate cancer diagnosis.

Molecular biomarkers and genomic classifiers can improve cancer characterization and treatment decisions.

Abstract

A group of experts in the care of patients with prostate cancer analyzed challenging aspects related to the diagnosis and management of the disease. These specialists reviewed evidence-based data reported in the literature, and after discussion together with their own experience, a narrative review was developed. The aim of the review was to provide updated information on diagnostic aspects and the most adequate treatment approaches for different stages of prostate cancer. Some important conclusions included: (1) the need to provide care within the framework of a multidisciplinary team; (2) the importance of tailoring treatment to individual preferences and values in a shared decision-making model, particularly regarding screening of prostate cancer; (3) the promising role of imaging techniques, such as prostate-specific membrane antigen/positron emission tomography/computed tomography due to their sensitivity; and (4) to focus further research in validation studies of molecular biomarkers for improving characterization of prostate cancer in clinical practice.

A group of experts of different specialties involved in the care of prostate cancer (PCa) patients participated in the ENFOCA2 project, promoted by the Spanish Oncology Genitourinary Group (SOGUG), with the aim to review, discuss, and summarize current relevant aspects related to screening, diagnosis, imaging, risk-based approach, and molecular characterization of PCa. A multidisciplinary team (MDT) approach is essential to ensure that patients receive evidence-based care, promoting shared decision-making, and tailoring treatment to the patient’s unique values and preferences. Population-based screening based on risk-stratified algorithms is needed to overcome the limitations of opportunistic screening for detecting clinically significant PCa. Next-generation imaging (NGI) methods, such as prostate-specific membrane antigen (PSMA) PET/CT alone or combined with multiparametric MRI (mpMRI), have a promising role in different scenarios of the diagnostic process due to their high sensitivity. The diagnostic yield of mpMRI should be improved, especially for assessing extraprostatic extension. The use of specific molecular probes as imaging markers for MRI could improve the staging of metastatic disease. Protocols for germline testing developed by international societies, such as the European Association of Urology (EAU) and the National Comprehensive Cancer Network (NCCN), should be adapted at local levels, with BRCA1/2, ATM, PALB2, CHEK2, MLH1, MSH2, MSH6, PMS2, EPCAM, and HOXB13 as the genes to be investigated. Genomic classifier tools help identifying aggressiveness of cancers and aid in personalized treatment decision-making. Joint efforts of multidisciplinary physicians are crucial to improve health outcomes for patients with PCa across the spectrum of this disease.

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