Combination treatments have improved survival in metastatic hormone-sensitive prostate cancer, but guidelines have offered little clear direction on when to use triplet therapy, combining androgen deprivation therapy with docetaxel and an androgen receptor-targeted agent, rather than a two-drug approach. Without agreed criteria, clinicians have been left to judge for themselves which patients should receive it.
To bring consensus, a steering group of eight UK specialists developed 39 statements across four topic areas. The statements were tested through a modified Delphi consensus, with a survey completed by 120 UK healthcare professionals including oncologists, urologists, geriatricians, nurse specialists and pharmacists. Consensus was pre-specified at 75% agreement, with very high agreement set at 90%.
Thirty-seven of the 39 statements reached consensus, and more than two thirds reached very high agreement. The panel agreed that androgen deprivation therapy alone is no longer the accepted standard of care, and that triplet therapy improves overall survival compared with androgen deprivation plus docetaxel and should be considered in all suitable patients.
Triducive acted as the independent facilitator for this consensus programme, generating the statements and analysing the responses. The recommendations help clinicians identify the patients most likely to benefit from triplet treatment and support consistent decision-making within the multidisciplinary team.
Glen H, et al. BMJ Open, 2024; 14(11): e090013. DOI: 10.1136/bmjopen-2024-090013
