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Background: With the availability of second-generation androgen receptor inhibitors (SGARIs), the treatment landscape has changed dramatically for patients with nonmetastatic castration-resistant prostate cancer (nmCRPC). In clinical trials, the SGARIs (apalutamide, enzalutamide, darolutamide) increased metastasis-free survival (MFS), overall survival (OS), and patient quality of life compared to placebo. These drugs were subsequently integrated into nmCRPC clinical practice guidelines. With advances in radiographic imaging, disease assessment, and patient monitoring, nmCRPC strategies are evolving to address limitations related to tracking disease progression using prostate-specific antigen (PSA) kinetics., Methods: A panel of 10 multidisciplinary experts in prostate cancer conducted reviews and discussions of unmet needs in the management and monitoring of patients with nmCRPC in order to develop consensus recommendations., Results: Across the SGARI literature, patient MFS and OS are generally comparable for all treatments, but important distinctions exist regarding short- and long-term drug safety profiles and drug-drug interactions. With respect to disease monitoring, a substantial proportion of patients using SGARIs may experience disease progression without rising PSA levels, suggesting a need for enhanced radiographic imaging in addition to PSA monitoring. Recent data also indicate that novel prostate-specific membrane antigen positron emission tomography radiotracers provide enhanced accuracy for disease detection, as compared to conventional imaging., Conclusions: Clinical decision-making in nmCRPC has become more complex, with new opportunities to apply precision medicine to patient care. Multidisciplinary teams can ensure that patients with nmCRPC receive optimal and individualized disease management., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Accurate estimation of kidney function is essential for patient selection and drug dosing in patients with cancer. eGFR equations are necessary for decision making and monitoring. Our aim was to identify which of these equations-estimated creatinine clearance (eCrCl) by Cockcroft-Gault (CG), eGFR by Modification of Diet in Renal Disease (eGFR MDRD ), CKD Epidemiology Collaboration (eGFR CKD-EPI ) or the recently proposed Janowitz-Williams equation (eGFR J-W )-would be most suitable for GFR estimation among patients with cancer receiving cisplatin., Methods: We assembled a cohort of 5274 patients with cancer treated with cisplatin-based chemotherapy at two large cancer centers. We ascertained the frequency of cisplatin-associated AKI (C-AKI) defined as a ≥0.3 mg/dl rise in serum creatinine over baseline. We compared baseline eGFR and eCrCl using Bland-Altman (B-A) plots, coefficients of variation (CV), and concordance correlation coefficients. We calculated the positive predictive value (PPV), negative predictive value (PPV), accuracy, and area under the curve (AUC)., Results: Patients were predominantly middle aged (median 58 years, IQR 49-66 years), overweight (median BMI 26.2, IQR 23.1-29.8 kg/m 2 ), and White (88%), with a median baseline creatinine of 0.8 mg/dl and median cisplatin dose of 99 mg. C-AKI developed in 12% of the cohort. eGFR CKD-EPI had the highest PPV and AUC. eGFR CKD-EPI and eGFR MDRD , along with their BSA-modified counterparts, had the closest agreement with the lowest CV (7.2, 95% CI, 7.0 to 7.3) and the highest concordance. C-AKI was lowest when using eGFR CKD-EPI to define eGFR ≥60 ml/min per 1.73 m 2 ., Conclusions: On the basis of its superior diagnostic performance, eGFR CKD-EPI should be used to estimate GFR in patients being considered for cisplatin-based chemotherapy., Competing Interests: A. Partridge reports receiving royalties as an author from UpToDate and received travel support from Novartis during the conduct of the study. G. Curhan reports receiving personal fees from AstraZeneca, Dicerna, OM1, Orfan, Merck, RenalGuard, and Shire/Takeda; receiving grants from Shoebox Audiometry outside the submitted work; receiving grants and personal fees from Decibel Therapeutics, and royalties from UpToDate. S. Motwani reports having a salaried position as a Deputy Editor at UpToDate (Wolters Kluwer). S. Waikar reports receiving personal fees from Cerus, CVS, GlaxoSmithKline, Harvard Clinical Research Institute, Janssen, Mass Medical International, Strataca, Takeda, Venbio, and Wolters Kluwer; receiving grants and personal fees from Allena; and has served as an expert witness for litigation related to cisplatin nephrotoxicity, Granuflo, mercury exposure, Omniscan, and statins, all unrelated to this study. T. Choueiri reports holding a patent; reports research (institutional and personal) with Analysis Group, Alexion, AstraZeneca, Bayer, Bristol Myers-Squibb/ER Squibb and sons LLC, Calithera, Cerulean, Corvus, Eisai, Exelixis, Foundation Medicine Inc., F. Hoffmann-La Roche, Genentech, GlaxoSmithKline, Lilly, Merck, Novartis, Peloton, Pfizer, Prometheus Labs, Roche, Roche Products, Sanofi/Aventis, Takeda, and Tracon; reports receiving honoraria from American Society of Medical Oncology, AstraZeneca, Alexion, Sanofi/Aventis, Bayer, Bristol Myers-Squibb/ER Squibb and sons LLC, Cerulean, Clinical Care Options, Corvus, Eisai, EMD Serono, Exelixis, F. Hoffmann-La Roche, Foundation Medicine Inc., Genentech, GlaxoSmithKline, Harborside Press, Heron Therapeutics, Ipsen, Kidney Cancer Journal, L-path, Lancet Oncology, Lilly Oncology, Michael J. Hennessy Associates, Inc (Healthcare Communications Company with several brands such as OnClive, PeerView and Physicians' education resource), Merck, Navinata Healthcare, National comprehensive cancer network (NCCN) Analysis Group, Novartis, Peloton, Pfizer, Platform Q, Prometheus Labs, Roche, Roche Products, Research to Practice, New England Journal of Medicine, and Up-to-Date; reports have a consulting or advisory role at Alexion, AstraZeneca, Bayer, Bristol Myers-Squibb/ER Squibb and sons LLC, Cerulean, Corvus, Eisai, EMD Serono, Exelixis, Foundation Medicine Inc., Genentech, GlaxoSmithKline, Heron Therapeutics, Ipsen, Lilly, Lilly Ventures Merck, NCCN Analysis Group, Novartis, Peloton, Pfizer, Pionyr, Prometheus Labs, Roche, Sanofi/Aventis, Tempest, and Up-to-Date; reports stock ownership with Pionyr and Tempest; reports other present or past leadership roles as Director of GU Oncology Division at DF and past President of medical Staff at DF, member of NCCN Kidney panel and the Genitourinary Steering Committee, past chairman of the Kidney Cancer Association Medical and Scientific Steering Committee), KidneyCan Advisory board, Kidney Cancer Research Summit cochair (2019-); reports patents, royalties or other intellectual properties through the International Patent Application No. PCT/US2018/12209, entitled “PBRM1 Biomarkers Predictive of Anti-Immune Checkpoint Response,” filed January 3, 2018, claiming priority to US Provisional Patent Application No. 62/445,094, filed January 11, 2017, International Patent Application No. PCT/US2018/058430, entitled “Biomarkers of Clinical Response and Benefit to Immune Checkpoint Inhibitor Therapy,” filed October 31, 2018, claiming priority to US Provisional Patent Application No. 62/581,175, filed November 3, 2017; reports travel, accommodations, expenses, in relation to consulting, advisory roles, or honoraria as medical writing and editorial assistance support may have been funded by communications companies funded by pharmaceutical companies (ClinicalThinking, Envision Pharma Group, Fishawack Group of Companies, Health Interactions, Parexel, Oxford PharmaGenesis); the institution (DFCI) may have received additional independent funding of drug companies or/and royalties potentially involved in research around the subject matter; CV provided upon request for scope of clinical practice and research; mentored several non-US citizens on research projects with potential funding (in part) from non-US sources/Foreign Components. Asmar Wood is a private company based in Beirut, Lebanon that provided a total of $100,000 in salary support to S. Alaiwi from July 1, 2018 to July 1, 2020 during her postdoctoral research fellowship at DFCI. Fondation Arc Pour La Recherche Sur Le Cancer is a not-for-profit foundation based in Villejuif, France that provided €2561.04/mo in salary support to R. Flippot during his clinical training at DFCI from May 2, 2018 to November 4, 2018. All remaining authors have nothing to disclose., (Copyright © 2021 by the American Society of Nephrology.)