成像和分子表征的创新以及新疗法的进化已经改善了晚期前列腺癌的结果。然而，我们仍然缺乏对许多临床主题的高水平证据，这对日常实践有很大影响。为了补充基于证据的指南，2022年前列腺癌高级共识会议（APCCC 2022）调查了专家们在临床管理中面临的关键难题。本文介绍了APCCC 2022中选择问题的共识投票结果。大会前，117名国际前列腺癌专家小组使用修正的德尔菲程序制定了 198 个多项选择共识问题，包括（1）中高风险和局部晚期前列腺癌，（2）局部治疗后的生化复发，（3）激素治疗的副作用，（4）转移激素敏感前列腺癌，（5）非转移性去势抵抗前列腺癌，（6）转移性去势抵抗前列腺癌和（7）少量转移和少量进展的前列腺癌。大会前，这些问题通过网络调查的形式提供给了105位直接参与前列腺癌治疗决策的医师小组成员（“专家团成员”）。本文中，我们展示了涉及主题 1-3 的82个问题的结果。一致性被定义为≥75%的一致，强烈的一致性被定义为≥90%的一致。投票结果显示了不同程度的共识，如本文所讨论的，并在补充资料中显示了详细结果。这些发现反映了国际专家小组的意见，未包括正式的文献评价和荟萃分析。这些由一组国际前列腺癌专家的投票结果可以帮助医生和患者应对争议的临床管理领域，这些领域缺乏高水平证据或存在冲突。这些发现还可以帮助资助者和政策制定者优先考虑未来研究的领域。诊断和治疗决策应该根据患者和癌症特点（疾病范围和部位、治疗历史、共病和患者偏好）个性化，并应包括当前和新兴的临床证据、治疗指南、逻辑和经济因素。参加临床试验是强烈鼓励的。重要的是，APCCC 2022再次确定了重要的差距（非共识领域），这些领域值得进行特定设计的试验。前列腺癌高级共识会议（APCCC）提供了一个讨论和辩论诊断和治疗晚期前列腺癌患者的当前选择的平台。会议旨在向全世界的卫生保健提供者和患者分享国际前列腺癌专家的知识。在每次APCCC上，一组医师专家针对多项选择问题投票，评估其临床意见和管理晚期前列腺癌的方法。本报告介绍了与中高风险和局部晚期前列腺癌、肯定治疗后的生化复发、先进的（下一代）成像以及激素治疗引起的副作用有关的问题的子集的投票结果。这些结果提供了一个实用的指南，帮助临床医生和患者在共同的多学科决策制定中讨论治疗选择。当没有高水平的证据可以指导治疗决策时，这些发现可能会特别有用。Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

Innovations in imaging and molecular characterisation and the evolution of new therapies have improved outcomes in advanced prostate cancer. Nonetheless, we continue to lack high-level evidence on a variety of clinical topics that greatly impact daily practice. To supplement evidence-based guidelines, the 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) surveyed experts about key dilemmas in clinical management.To present consensus voting results for select questions from APCCC 2022.Before the conference, a panel of 117 international prostate cancer experts used a modified Delphi process to develop 198 multiple-choice consensus questions on (1) intermediate- and high-risk and locally advanced prostate cancer, (2) biochemical recurrence after local treatment, (3) side effects from hormonal therapies, (4) metastatic hormone-sensitive prostate cancer, (5) nonmetastatic castration-resistant prostate cancer, (6) metastatic castration-resistant prostate cancer, and (7) oligometastatic and oligoprogressive prostate cancer. Before the conference, these questions were administered via a web-based survey to the 105 physician panel members ("panellists") who directly engage in prostate cancer treatment decision-making. Herein, we present results for the 82 questions on topics 1-3.Consensus was defined as ≥75% agreement, with strong consensus defined as ≥90% agreement.The voting results reveal varying degrees of consensus, as is discussed in this article and shown in the detailed results in the Supplementary material. The findings reflect the opinions of an international panel of experts and did not incorporate a formal literature review and meta-analysis.These voting results by a panel of international experts in advanced prostate cancer can help physicians and patients navigate controversial areas of clinical management for which high-level evidence is scant or conflicting. The findings can also help funders and policymakers prioritise areas for future research. Diagnostic and treatment decisions should always be individualised based on patient and cancer characteristics (disease extent and location, treatment history, comorbidities, and patient preferences) and should incorporate current and emerging clinical evidence, therapeutic guidelines, and logistic and economic factors. Enrolment in clinical trials is always strongly encouraged. Importantly, APCCC 2022 once again identified important gaps (areas of nonconsensus) that merit evaluation in specifically designed trials.The Advanced Prostate Cancer Consensus Conference (APCCC) provides a forum to discuss and debate current diagnostic and treatment options for patients with advanced prostate cancer. The conference aims to share the knowledge of international experts in prostate cancer with health care providers and patients worldwide. At each APCCC, a panel of physician experts vote in response to multiple-choice questions about their clinical opinions and approaches to managing advanced prostate cancer. This report presents voting results for the subset of questions pertaining to intermediate- and high-risk and locally advanced prostate cancer, biochemical relapse after definitive treatment, advanced (next-generation) imaging, and management of side effects caused by hormonal therapies. The results provide a practical guide to help clinicians and patients discuss treatment options as part of shared multidisciplinary decision-making. The findings may be especially useful when there is little or no high-level evidence to guide treatment decisions.Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.