Skip to main content
. Author manuscript; available in PMC: 2023 Jul 4.
Published in final edited form as: Eur Urol. 2022 Dec 6;83(3):267–293. doi: 10.1016/j.eururo.2022.11.002

Table 1. APCCC 2022 questions concerning intermediate- and high-risk and locally advanced prostate cancer that have reached consensus.

Question Answers Voting results, % (n)
1. Are you in favour of refining the metastatic classification (N and M) in TNM to have a notation for PSMA PET-positive lesions (eg, as suggested by the PROMISE paper)? 1. Yes 87 (89), consensus
2. No 13 (13)
2. Do you recommend PSMA PET in the majority of patients with clinically localised high-risk localised prostate cancer? 1. Yes 77 (79), consensus
2. No 23 (23)
4. Do you recommend PSMA PET in the majority of patients with clinically localised favourable intermediate-risk (NCCN definition) localised prostate cancer? 1. Yes 8(8)
2. No 92 (95), strong consensus
5. If you recommend PSMA PET for systemic staging of clinically localised prostate cancer, what do you recommend (in addition to the MRI of the prostate)? 1. PSMA PET only after conventional imaging negative or indeterminate 22 (19)
2. Upfront PSMA PET with or without subsequent conventional imaging 78 (66), consensus
6. In the majority of patients with clinically localised prostate cancer and PSMA positivity, with metastasis-consistent findings in the bone on the CT part of upfront PSMA PET, do you recommend any additional imaging (eg, MRI, bone scintigraphy)? 1. Yes 22 (22)
2. No 78 (80), consensus
8. Do you recommend whole-body, diffusion-weighted MRI for systemic staging in the majority of patients with clinically localised high-risk prostate cancer? 1. Yes 9(9)
2. No 91 (93), strong consensus
9. Do you recommend whole-body, diffusion-weighted MRI for systemic staging in the majority of patients with clinically localised intermediate-risk prostate cancer? 1. Yes 5(5)
2. No 95 (97), strong consensus
15. In the majority of patients with high-risk localised (STAMPEDE definition) prostate cancer (≥2 out of 3 criteria: cT3/T4, PSA ≥40, Gleason 8–10) and N0 M0 on nextgeneration imaging, what is your recommended systemic therapy in combination with local radiation therapy? 1. ADT alone for 2–3 yr 21 (22)
2. ADT for 2–3 yr plus abiraterone for 2 yr 78 (80), consensus
3. ADT for 2–3 yr plus docetaxel 6 cycles 1 (1)
16. In the majority of patients with very-high-risk localised prostate cancer (NCCN definition: at least one of the following: cT3b-cT4, primary Gleason pattern 5, 2 or 3 high-risk features, >4 cores of ISUP grade group 4 or 5) and N0 M0 on next-generation imaging, what is your recommended systemic therapy in combination with radiation therapy to the primary? 1. ADT alone for 2–3 yr 17 (17)
2. ADT for 2–3 yr plus abiraterone for 2 yr 78 (80), consensus
3. ADT for 2–3 yr plus docetaxel 6 cycles 5(5)
19. In the majority of patients with high/very-high-risk localised prostate cancer (cN0 on conventional imaging) undergoing RT of the prostate, do you recommend irradiation to pelvic nodes? 1. Yes 83 (70), consensus
2. No 17(14)
23. For the majority of patients with 1 or 2 pathologically involved pelvic lymph nodes following radical surgery with extended PLND (pN1 and no high-risk features: ISUP grade group 4–5 or pT3 or positive margins) without evidence of metastases on preoperative staging, with undetectable postoperative PSA, what is your recommendation provided the patient has regained continence? 1. Monitoring alone and salvage therapy in case of PSA rise 81 (83), consensus
2. Adjuvant radiation therapy 1 (1)
3. Adjuvant radiation therapy plus systemic hormonal treatment 15 (15)
4. Systemic hormonal treatment alone 3(3)
27. For the majority of patients with a high risk of relapse following radical prostatectomy (R0), extended PLND, and undetectable postoperative PSA, and with both Gleason 8–10 and pT3b/T4 but pN0, which treatment do you recommend provided the patient has regained continence? 1. Immediate adjuvant RT ± systemic hormonal treatment 16 (16)
2. Monitoring and early salvage RT ± systemic hormonal treatment if PSA rises 84 (83), consensus

ADT = androgen deprivation therapy; APCCC = Advanced Prostate Cancer Consensus Conference; CT = computed tomography; ISUP = International Society of Urological Pathology; MRI = magnetic resonance imaging; NCCN = National Comprehensive Cancer Network; PET = positron emission tomography; PLND = pelvic lymph node dissection; PSA = prostate-specific antigen; PSMA = prostate-specific membrane antigen; RT = radiation therapy; TNM = tumour, node, metastasis.