Management of patients with castration-resistant prostate cancer (CRPC): Results of an Italian survey using the delphi method

Purpose: To assess the opinions of urologists, oncologists and radiation oncologists on the indication for androgen deprivation therapy (ADT) and the definition and management of castration-resistant prostate cancer (CRPC). Methods: In this study using the Delphi method, a list of 15 statements (66 items overall) addressing key issues in ADT and CRPC was sent to 255 participants (urologists, oncologists and radiation oncologists). Responses were rated on a 5-point Likert scale (1=strong disagreement; 5=strong agreement). Disagreement was defined as =66% responses with scores 1-2 and agreement as =66% responses with scores 3-5. No consensus was absence of agreement/disagreement. Results: Overall, there was agreement and disagreement in 50% and 15% of the items, respectively. In 71.2% of the items the panelists agreed with each other. The highest concordance rate was observed between urologists and oncologists (87.8%). There were no items with 3 different opinions between the specialists. All panelists agreed on the definition of CRPC. Urologists and oncologists agreed on the recommendation to continue ADT in CRPC. In both nonmetastatic and metastatic asymptomatic CRPC patients with biochemical progression, treatment should be based on PSA kinetics. The panelists agreed on the use of chemotherapy in symptomatic and asymptomatic metastatic CRPC patients but not in those with nonmetastatic CRPC. There was agreement on the timing of initiation of abiraterone and enzalutamide either before or after chemotherapy. Conclusions: With few exceptions there was agreement among urologists, oncologists and radiation oncologists about the management of CRPC, although the indications were not always in line with international guidelines.