Establishing consensus recommendations for metastatic hormone-sensitive prostate cancer in South Korea: A modified Delphi study

• Published in: Investigative and clinical urology Vol. 66; no. 5; pp. 416 - 430
• Main Authors: Joung, Jae Young, Jeong, In Gab, Kang, Sung Gu, Ko, Young Hwii, Koo, Kyo Chul, Kim, Kwang Hyun, Kim, Myung Ki, Kim, Soodong, Kim, Jeong Hyun, Park, Sung-Woo, Park, Jae Young, Song, Wan, Lee, Seung Hwan, Jung, Seung Il, Chung, Jae Hoon, Jeong, Chang Wook, Joo, Kwan Joong, Choi, Seock Hwan, Choi, Se Young, Choo, Seol Ho, Ha, Hong Koo, Hong, Sung Kyu, Hong, Sung-Hoo, Hong, Jeong Hee, Hong, Jun Hyuk, Kim, Sun Il, Kwak, Cheol, Jeon, Seong Soo
• Format: Journal Article
• Language: English
• Published: Korea (South) 대한비뇨의학회 01.09.2025
• Subjects: Androgen Antagonists - therapeutic use; Androgen Receptor Antagonists - therapeutic use; Consensus; Delphi Technique; Humans; Male; Neoplasm Metastasis; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - pathology; Prostatic Neoplasms - therapy; Republic of Korea; 비뇨기과학; Republic of Korea; Prostate cancer; Consensus development; Evidence-based practice
• ISSN: 2466-0493; 2466-054X; 2466-054X
• DOI: 10.4111/icu.20250147

Consensus is lacking among South Korean urologists on the appropriate treatment of metastatic hormone-sensitive prostate cancer (mHSPC). A modified, Delphi-based consensus on managing mHSPC patients was developed to support clinical decision-making. Thirty-six questions on mHSPC treatment were developed by an expert committee (five urologists). Nine questions required achievement of consensus (key questions). Twenty-three urologists participated in two rounds of a Delphi survey. Consensus was defined as ≥75% agreement among panelists, with ≥90% agreement representing strong consensus. Eighteen questions (50.0%) reached strong consensus, 15 (41.7%) reached consensus, and three (8.3%) reached no consensus. Eight key questions (88.9%) reached strong consensus and one (11.1%) reached consensus. Consensus was reached on recommending androgen-deprivation therapy (ADT) intensification, irrespective of disease volume or type, with an androgen receptor pathway inhibitor (ARPI) as the preferred option. Not using docetaxel alone with ADT when an ARPI is available for treatment intensification was recommended (strong consensus). For high-volume mHSPC patients with a pathogenic, speckle-type poxvirus and zinc finger protein mutation, ADT+ARPI was recommended over triplet therapy (strong consensus). Panelists recommended regular imaging every 6-12 months if no ARPI reimbursement restrictions exist, but a 3-month interval (per current reimbursement guidelines) otherwise. ADT+ARPI was the most recommended systemic treatment (strong consensus). This Delphi consensus established local consensus on controversial areas of mHSPC management. The findings offer meaningful perspectives that may help shape future treatment strategies and encourage thoughtful reconsideration of reimbursement criteria to align evidence and clinical practice in South Korea.