Consenso sobre el manejo del cáncer de próstata resistente a la castración avanzado en España.

espanolOBJETIVOS: Establecer recomendaciones sobre la practica clinica habitual del manejo del cancer de prostata resistente a la castracion (CPRC) en Espana. METODOS: Un panel de 18 expertos en Urologia con experiencia en el manejo del CPRC participaron en un proceso Delphi modificado a dos rondas con una reunion final presencial. El panel considero un total de 106 cuestiones clinicas divididas en las siguientes secciones: definicion del CPRC, diagnostico de metastasis por tecnicas de imagen, sintomatologia, progresion, manejo de M0 y M1 y secuenciacion terapeutica. RESULTADOS: Se recomienda realizar una gammagrafia osea (GO) en el diagnostico, al comienzo del dolor oseo y dependiendo de los niveles de PSA. La resonancia magnetica de cuerpo entero y la axial son mas sensibles que la GO y la radiografia, pero mas caras, por lo que se reservan para ciertas situaciones. Existe progresion del CPRC cuando se confirma la progresion radiologica, clinica o por PSA. El fenomeno “flare” aparece en el tratamiento con taxanos y abiraterona. En pacientes M0 no se recomienda tratamiento farmacologico actualmente, y el tratamiento en primera linea para los pacientes M1 incluiria principalmente enzalutamida/ abiraterona y/o docetaxel, segun los sintomas. CONCLUSION: Se proponen recomendaciones para personalizar la toma de decisiones ante cada paciente, el uso de tecnicas de imagen y como abordar la progresion de la enfermedad para mejorar la calidad de vida de los pacientes. EnglishOBJECTIVES: To move towards a more standardized approach in clinical practice to manage patients with castration-resistant prostate cancer (CRPC) in Spain. METHODS: A panel of 18 Spanish experts in Urology with expertise managing CRPC followed a modified Delphi process with two rounds and a final face-to-face consensus meeting. The panel considered a total of 106 clinical questions divided into the following 6 sections: definition of CRPC, diagnosis of metastases by imaging techniques, symptoms of CRPC, progression of CRPC, M0 and M1 management and therapeutic sequencing. RESULTS: A bone scan (BS) is recommended at diagnosis, at the onset of bone pain, and depending on PSA levels, but it is not sensitive enough to confirm or exclude bone metastases if there is bone pain. Whole-body MRI and axial MRI are more sensitive than BS and plain X-rays, but more expensive, so they have to be used in certain situations. There is CRPC progression when there is radiologic, clinical or confirmed PSA progression. Flare phenomenon appears in treatment with taxanes and abiraterone. It was agreed that in M0 CRPC patients no drug treatment is currently recommended, although in M1 CRPC patients the first-line therapy would be mainly enzalutamide/abiraterone and/or docetaxel, depending on the symptom burden. CONCLUSION: After the consensus, we provide a series of recommendations for Spanish physicians treating CRPC to address the disease characteristics how to tailor patient management decisions, the use of imaging techniques, and how to handle disease progression appropriately to improve patients’ quality of life.