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

Jae Young Joung; In Gab Jeong; Sung Gu Kang; Young Hwii Ko; Kyo Chul Koo; Kwang Hyun Kim; Myung Ki Kim; Soodong Kim; Jeong Hyun Kim; Sung-Woo Park; Jae Young Park; Wan Song; Seung Hwan Lee; Seung Il Jung; Jae Hoon Chung; Chang Wook Jeong; Kwan Joong Joo; Seock Hwan Choi; Se Young Choi; Seol Ho Choo; Hong Koo Ha; Sung Kyu Hong; Sung-Hoo Hong; Jeong Hee Hong; Jun Hyuk Hong; Sun Il Kim; Cheol Kwak; Seong Soo Jeon

doi:10.4111/icu.20250147

YUHSpace

BROWSE

7 22

Cited 0 times in

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

Authors: Jae Young Joung ; In Gab Jeong ; Sung Gu Kang ; Young Hwii Ko ; Kyo Chul Koo ; Kwang Hyun Kim ; Myung Ki Kim ; Soodong Kim ; Jeong Hyun Kim ; Sung-Woo Park ; Jae Young Park ; Wan Song ; Seung Hwan Lee ; Seung Il Jung ; Jae Hoon Chung ; Chang Wook Jeong ; Kwan Joong Joo ; Seock Hwan Choi ; Se Young Choi ; Seol Ho Choo ; Hong Koo Ha ; Sung Kyu Hong ; Sung-Hoo Hong ; Jeong Hee Hong ; Jun Hyuk Hong ; Sun Il Kim ; Cheol Kwak ; Seong Soo Jeon

Citation: INVESTIGATIVE AND CLINICAL UROLOGY, Vol.66(5) : 416-430, 2025-09

Journal Title: INVESTIGATIVE AND CLINICAL UROLOGY

ISSN: 2466-0493

Issue Date: 2025-09

MeSH: 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

Keywords: Consensus development ; Evidence-based practice ; Prostate cancer

Abstract: Purpose: 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.

Materials and methods: 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.

Results: 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).

Conclusions: 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.