First brazilian consensus of advanced prostate cancer: recommendations for clinical practice

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Vol. 43 (3): 407-415, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0490


Andre Deeke Sasse 1, Evanius Garcia Wiermann 2, Daniel Herchenhorn 3, Diogo Assed Bastos 4, 5, Fabio A. Schutz 6, Fernando Cotait Maluf 6, 7, George Coura Filho 8, Igor Alexandre Protzner Morbeck 9, Juliano J. Cerci 10, Oren Smaletz 7, Volney Soares Lima 11, Ari Adamy Jr. 12, Franz Santos de Campos 3, Gustavo Franco Carvalhal 13, Leandro Casemiro Cezar 14, Marcos Francisco Dall´Oglio 15, Marcus Vinicius Sadi 16, Rodolfo Borges dos Reis 17, Lucas Nogueira 18
 1 Clínica Médica, Unicamp, Campinas, SP, Brasil; 2 Sociedade Brasileira de Oncologia Clinica, Belo Horizonte, MG, Brasil; 3 Instituto Nacional do Câncer, INCA, Rio de Janeiro, RJ, Brasil; 4 Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil; 5 Departamento de Oncologia, Hospital Sirio-Libanes, São Paulo, SP, Brasil; 6 Beneficiência Portuguesa de São Paulo, São Paulo, SP, Brasil; 7 Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; 8 Instituto do Câncer, Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil; 9 Universidade Católica de Brasilia, Taguatinga, DF, Brasil; 10 Universidade de São Paulo, USP, São Paulo, SP, Brasil; 11 Oncocentro, Belo Horizonte, MG, Brasil; 12 Departamento de Urologia, Hospital Santa Casa, Curitiba, PR, Brasil; 13 Departamento de Cirurgia e Departamento de Urologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil; 14 Hospital Federal Cardoso Fontes, Rio de Janeiro, RJ, Brasil; 15 Departamento de Urologia, Universidade de São Paulo, USP, São Paulo, SP, Brasil; 16 Universidade Federal de São Paulo, São Paulo, SP, Brasil; 17 Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil; 18 Departamento de Urologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte. MG, Brasil


Introduction: Prostate cancer still represents a major cause of morbidity, and still about 20% of men with the disease are diagnosed or will progress to the advanced stage with­out the possibility of curative treatment. Despite the recent advances in scientific and technological knowledge and the availability of new therapies, there is still considerable heterogeneity in the therapeutic approaches for metastatic prostate cancer.

Objectives: This article presents a summary of the I Brazilian Consensus on Advanced Prostate Cancer, conducted by the Brazilian Society of Urology and Brazilian Society of Clinical Oncology.

Materials and Methods: Experts were selected by the medical societies involved. Forty issues regarding controversial issues in advanced disease were previously elaborated. The panel met for consensus, with a threshold established for 2/3 of the participants.

Results and Conclusions: The treatment of advanced prostate cancer is complex, due to the existence of a large number of therapies, with different response profiles and toxici­ties. The panel addressed recommendations on preferred choice of therapies, indicators that would justify their change, and indicated some strategies for better sequencing of treatment in order to maximize the potential for disease control with the available therapeutic arsenal. The lack of consensus on some topics clearly indicates the absence of strong evidence for some decisions.

Keywords:  Prostatic Neoplasms; Practice Guideline [Publication Type]; Diagnosis

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