A roadmap for future clinical research in advanced prostate cancer: Findings from the Advanced Prostate Cancer Consensus Conference (APCCC) 2024.

[BACKGROUND] The Advanced Prostate Cancer Conference (APCCC) addresses many aspects of advanced prostate cancer management, including areas lacking high-level evidence. The 2024 APCCC conference defined consensus as ≥ 75 % agreement among the expert panellists, which was not reached for many questions.

[METHODS] An invited panel of 120 experts ("panellists") voted via a web-based survey on 183 multiple-choice questions prior to the APCCC 2024 conference. Consensus was not reached for 143 (78 %) of the questions, highlighting persistent evidence gaps. We reviewed clinicaltrials.gov and clinicaltrialsregister.eu to identify relevant ongoing phase 3 trials in these areas of non-consensus.

[RESULTS] Numerous ongoing phase 3 trials were identified that may help address some of the gaps identified by expert voting. However, several topics without consensus are not currently being investigated in clinical trials.

[CONCLUSIONS] Lack of consensus may stem from absent or limited high-level evidence, differing interpretations of existing data, or complete gaps in available data. The large number of questions without consensus at APCCC 2024 underscores the complexity of advanced prostate cancer care and the urgent need for trials generating robust evidence to guide practice. Furthermore, ongoing progress to improve our understanding of prostate cancer disease biology, including the identification of novel therapeutic targets, will likely identify additional areas of uncertainty. This manuscript highlights key directions for research by mapping areas without consensus against the landscape of current clinical trials.