Management of patients with high-risk and advanced prostate cancer in the Middle East: resource-stratified consensus recommendations

Deborah Mukherji 1, Bassem Youssef 2, Christelle Dagher 3, Albert El-Hajj 4, Rami Nasr 4, Fadi Geara 2, Danny Rabah 5, Saad Al Dousari 6, Rabih Said 7, Raja Ashou 8, Wassim Wazzan 2, Michel Jabbour 9, George Farha 10, Nibras Al Hamdani 11, Yousuf Al Hallaq 11, Hassan Ghazal 12, Haifa Dbouk 13, Bassel Bachir 2, Clement El Khoury 14, Ghazi Sakr 15, Hero K Hussain 16, Khaled Sayyid 17, Khaled Ibrahim 18, Mohammad Haidar 16, Nicolas Zouain 19, Nizar Bitar 20, Walid Alameh 21, Fadi Abbas 22, Sami Faddoul 23, Elie Nemer 24, Georges Assaf 9, Fadi Farhat 18, Muhammad Bulbul 2, Sally Temraz 3, Ali Shamseddine 3, Silke Gillessen 25 26, Aurelius Omlin 26, Raja Khauli 27

Affiliations

03 January 2020

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doi: 10.1007/s00345-019-02872-x

Abstract

Purpose: Prostate cancer care in the Middle East is highly variable and access to specialist multidisciplinary management is limited. Academic tertiary referral centers offer cutting-edge diagnosis and treatment; however, in many parts of the region, patients are managed by non-specialists with limited resources. Due to many factors including lack of awareness and lack of prostate-specific antigen (PSA) screening, a high percentage of men present with locally advanced and metastatic prostate cancer at diagnosis. The aim of these recommendations is to assist clinicians in managing patients with different levels of access to diagnostic and treatment modalities.

Methods: The first Advanced Prostate Cancer Consensus Conference (APCCC) satellite meeting for the Middle East was held in Beirut, Lebanon, November 2017. During this meeting a consortium of urologists, medical oncologists, radiation oncologist and imaging specialists practicing in Lebanon, Syria, Iraq, Kuwait and Saudi Arabia voted on a selection of consensus questions. An additional workshop to formulate resource-stratified consensus recommendations was held in March 2019.

Results: Variations in practice based on available resources have been proposed to form resource-stratified recommendations for imaging at diagnosis, initial management of localized prostate cancer requiring therapy, treatment of castration-sensitive/naïve advanced prostate cancer and treatment of castration-resistant prostate cancer.

Conclusion: This is the first regional consensus on prostate cancer management from the Middle East. The following recommendations will be useful to urologists and oncologists practicing in all areas with limited access to specialist multi-disciplinary teams, diagnostic modalities and treatment resources.

Keywords: Consensus; Middle East; Multidisciplinary; Prostate cancer; Resource-stratified recommendations.

Conflict of interest statement

D Mukherji: research funding/honoraria from Astellas, Janssen, and Sanofi. A. Shamseddine: research funding/honoraria from Astellas, Janssen, and Sanofi. R. Khauli: research funding/honoraria from Astellas, Janssen, Hickma, and Algorithm. S. Gillessen: advisory role (including IDMCs) and Speakers Bureau: AAA International, Active Biotech, Amgen, Astellas Pharma, Bayer, Bristol-Myers Squibb, CellSearch, Clovis, CureVac, Dendreon, ESSA Pharmaceuticals, Ferring, Innocrin Pharmaceuticals, Janssen Cilag, MaxiVAX SA, Millenium, Nectar, Novartis, Orion, Pfizer, ProteoMediX, Roche, and Sanofi. Co-inventor on patent application (WO 2009138392 A1) for a method for biomarker discover (granted in China, Europe, Japan and the US). Deputy of the ESMO guidelines committee for GU cancers, member of the EAU guideline panel for prostate cancer, past chair of the EORTC GU group. Member of the STAMPEDE trial management group. All the other authors have no relevant conflicts of interest to declare.

Figures

Fig. 1 Areas of consensus (≥ 75% agreement) APCCC 2017 compared to Beirut Satellite Meeting 2017

Fig. 1 Areas of consensus (≥ 75% agreement) APCCC 2017 compared to Beirut Satellite Meeting 2017

Fig. 1 Areas of consensus (≥ 75% agreement) APCCC 2017 compared to Beirut Satellite Meeting 2017

Fig. 1 Areas of consensus (≥ 75% agreement) APCCC 2017 compared to Beirut Satellite Meeting 2017

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