Prostate Cancer Working Group 4 - New Terminology and Definitions

Those who know me, know I talk about learning the language, terms, definitions, so that you can speak the language and have graduate level discussions with your medical team about treatment.

Looks like they're moving the goal posts...I personally think it may be a good thing as it better frames our disease state. Old habits die hard though so will be interesting to see how long this takes to find its way into mainstream clinical practice...
https://www.urotoday.com/video-lectures/psma-and-beyond-2026-conference-videos/video/5546-how-pcwg4-impacts-future-trials-presentation-michael-morris.html
The medical community and perhaps its patients have wanted to move beyond the term castration because it's not a particularly friendly term for either patients or caregivers alike. It was developed in the context of Prostate Cancer Working Group 2 when there only had ADT, and so everything oriented around serum testosterone levels.

Now we have androgen synthesis inhibitors. We have really potent anti-androgen receptor drugs. We have new drugs that manipulate the AR in a variety of ways so we can move from a strictly endocrinologic definition to now a mechanistic one. And so we will be using Androgen Pathway Modulator as the core root terminology that's:

Naïve - APMN
Sensitive - APMS
Resistant - APMR.

That transition from APMS to APMR is really progression with ADT alone, or ADT and ARPI alone, or as a doublet, or as a triplet with another drug, or some future novel AR targeting agent.

APMR will now be designated according to prior therapy as opposed to first line, second line, third line. So you need to say PARP exposed, lutetium exposed, Taxane-based chemotherapy exposed, because in today's day and age, first line, second line, third line doesn't really tell us what's going on with the patient…

Kevin