Charles Ryan: Hello. I’m Charles Ryan from the University of Minnesota. Today we’re going to have a panel discussion about the upcoming APCCC meeting, a very important conference in our field thanks to the works of Silke Gillessen from St. Gallen and Manchester University and Aurelius Omlin, also from St. Gallen. So, I’m delighted that the two of you could join us. I’m also joined by Alicia Morgans from Northwestern University and Neal Shore from Carolina Urologic Research Center.

So, Silke, I’m going to start with you. Tell us a little bit about the history of this meeting and its importance in the field today.

Silke Gillesen: So, yes, I think it was an interesting start because in St. Gallen there’s also the Early Breast Cancer Consensus meeting, and Aurelius and me, we were having a coffee break once, and we were thinking, actually there is so many unclear questions in prostate cancer as well, so why is there no conference addressing these kind of situations in daily clinical practice, where you don’t have enough evidence, or you have evidence but the evidence is conflicting? And we started to just organize this conference. 2004, 2015, we started 2013 because it takes much more time than we thought at that moment, I have to say. So we were a bit naïve; we were thinking, oh, we’re just organizing this conference. And then obviously we have very, very good friends, and everyone was saying yes and helpful. It was really nice to come without honorarium to that conference.

And it started with a conference with about 40 panelists, experts in the field, and then, in the second year, it already had grown that much that we had about 50 panelists and much more participants; audience who wanted to come. So we had, actually, to decide for 2019, for this year, to change the conference center, because the conference center was just getting too small for everyone who wanted to come. So, I think this is a really nice sign of the success of that conference. It has been tried to be reproduced with satellite conferences in different regions. That was something that we really wanted to have, because our conference is actually really mostly asking questions in an ideal world, so you would have everything. You would have PSMA PET/CT, but also whole body MRI, you would have all the drugs available that are approved, so it’s an ideal setting. So, if you would have everything, what would you do?

But then, also, there are so many regions in the world where obviously the access to either diagnostics or also treatments; if it’s radiotherapy, if it’s cancer drugs, is just not the same as in the developed world. And, even in Europe, there’s big differences.

Charles Ryan: Right.

Silke Gillesen: So, there was these regional conferences that just looked at their region with the means they have there, and asked the same questions, so I think that was very, very illuminating, also, for us to see how different treatment and management is around the globe.

Charles Ryan: Right. That’s why it’s become so important. Now, Aurelius, tell us about the composition of the panel? From which parts of the world? Predominantly urologists, oncologists? Who do we expect to see?

Aurelius Omlin: Well, the panel in 2019 is about 70 experts in prostate cancer management. I think you can call it the who’s who of prostate cancer and treatment. It’s about a third urologists, a third oncologists, and the other third are nuclear medicine specialists, radiologists, radiation oncologists or clinical oncologists, and region-wise, it’s about a third US, a third Europe, and, again, the other third is spread all across the globe.

Charles Ryan: Terrific. Now, Neal, tell us what you think the importance of this is to the urological community? As Silke said, this is filling in gaps between the data, so to speak, right, between where there’s trials, and, as we know, there’s just not a paper or a trial for every question we face in the clinic.

Neal Shore: Yeah. Well, you’re absolutely right and, again, hats off and great appreciation to Silke and Aurelius. They just organically grew this because they had an idea, they had a notion, that there were all these unmet needs. Bring together some of the top people in the world, in an interdisciplinary way, and they keep expanding it. They keep expanding it throughout the entire globe; I think you said so; because there are some access issues and we’ve talked about that. This is for anyone who takes care of a patient with advanced prostate cancer, whether you’re a primary care physician, medical oncologist, urologist, radiation oncologist, nuc med, pathologist. So, we really encourage a lot of folks, if they want to come, it’s a beautiful venue, an opportunity to hear the real leading authorities in the world present in very short presentations, and then we will debate, and then we vote. And I think it’s remarkable what this has accomplished.

It was the most cited paper in European urology in 2017; the findings. So, it’s really for anyone who wants to take care of anyone with advanced prostate cancer.

Charles Ryan: So, to be clear, anybody can come to this meeting?

Silke Gillesen: Right.

Charles Ryan: They can register and come and be an attendee, even if they’re not involved with the panel?

Silke Gillesen: Right.

Aurelius Omlin: And I think what a lot of people appreciate is that it’s purely educational. There’s no presentation of exciting new data, the hottest topic that may not be available; it’s really conceptual and educational and then, as you said, we have these discussions and voting on Saturday.

Silke Gillesen: Yeah, and I want, perhaps, also to say that we also try to have topics there that, again, perhaps not that sexy, but so important for the patients. So, side effects of androgen deprivation therapy. It’s something is not talked about a lot in our meetings, right? So, it’s hot flashes, bone health; that’s something that’s really important to me. We have discussed about that. And I just think these are the topics that we don’t discuss enough in meetings because there’s also, it’s too cheap to be investigated, so there’s also not a lot of interest in studies there. But there are people, like experts, who have a lot of experience with it, and that’s the questions our patients have. What do I do with my hot flashes? So, as you said, it’s also even important for GPs, because sometimes that’s a question that comes to the GP.

Charles Ryan: One of the world’s great experts on patient reported outcomes is sitting right here to your left. I told Alicia this is an area that I think is important for you, and the use of the consensus and the ability for us to discuss these things. How does that integrate with your work on patient reported outcomes.

Alicia Morgans: I think patient reported outcomes can be important throughout this conference and actually are driving some of the questions that are being discussed at this conference. So, as Silke mentioned, the hot flash issue is something that we know about because our patients tell us that this is an area of concern. But Neal and I have participated in projects, trying to get consensus around, well, what do we actually do for hot flashes, and those small consensus discussions certainly are important and helpful, but can’t actually inform practice in the way that an international consensus at a conference like the APCCC can really do. So, we can have these conversations, we recognize that they’re important, because our patients tell us, but until we have these conversations, we don’t act on them. And the other thing that I would say is that this conference is addressing bone health, is addressing things that patients don’t always even realize are issues for them, but it can educate patients as well, as to what they need to think about, what they need to speak about with their physicians, so that they can take an active role in their disease process.

Charles Ryan: Yes, and one of the things I really like about it is, it integrates the physician’s experience after data has been published. So, we’ve had a few, for example, Phase 3 trials that were published four or five years ago now, and so we’ve all been practicing according to these trials, now, but we learned things as we go, and we learned things that aren’t covered in the trials. We learned that there were adverse events in the studies, that we didn’t appreciate how important they are moving forward, and that’s why patient reported outcomes and other factors are so important. You’ve mentioned… we’ve all mentioned consensus, and I what I want to talk about is what is consensus? How do we define that? If you say, Silke, that a consensus of clinicians agreed that we should do a particular treatment, what does that mean? How do you define consensus?

Alicia Morgans: And do we always find consensus at APCCC?

Silke Gillesen: No, unfortunately not. So, we define it with 75% of the panelists voting for the same option. So, obviously you can debate that. There is also other papers; there’s several papers about that you can use 70%. We decided on 75% to be very stringent. And, yes, to be honest, there’s lots of topics where there was no consensus in the last meeting, but, again, I think this is actually something that is so interesting that’s coming out of that meeting, because these are actually the topics where I think we should try to initiate some academically led, at least, studies.

And sometimes, again, this is perhaps not about the newest drug, but it’s about best use of our drugs that we have, and so I think this is really something that is really important; a result that comes out of the conference. And that we also decided, for 2019, we’re going to make much better use of it and really try to even make a paper and say these are the points, like a position paper; these are the points where we think, as an expert panel, that studies should be done. And I think this could be something important, that is now new for 2019, that comes out of the conference.

Charles Ryan: That’s terrific. And it has the attention of the whole world, now, treating this disease, including those with a greater supply of resources in therapies, and those with a lesser amount, and I think that’s really important. I also want to congratulate you both for putting this together. Thank you for including me; I’m really looking forward to it.

Silke Gillesen: Thank you for coming.

Charles Ryan: And we’ll see you in Basel, I guess, in August. Thank you so much.

Silke Gillesen: Thank you.

Aurelius Omlin: Thank you.

Alicia Morgans: Thank you.

Silke Gillesen: Thanks.