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

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

Affiliations

1Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, 1107 2020, Beirut, Lebanon. Dm25@aub.edu.lb.

2Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon.

3Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, 1107 2020, Beirut, Lebanon.

4Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, 1107 2020, Beirut, Lebanon.

5Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

6Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.

7Division of Hematology/Oncology, Department of Internal Medicine, Saint Georges Hospital University Medical Center, Beirut, Lebanon.

8Department of Radiology, Saint Georges Hospital University Medical Center, Beirut, Lebanon.

9Division of Urology, Department of Surgery, Saint Georges Hospital University Medical Center, Beirut, Lebanon.

10Department of Radiation Oncology, Mount Lebanon Hospital, Faculty of Medicine-University of Balamand, Beirut, Lebanon.

11Department of Surgery, Medical City Teaching Hospital Baghdad, Baghdad, Iraq.

12Division of Hematology/Oncology, Department of Internal Medicine, Clemenceau Medical Center, Beirut, Lebanon.

13Division of Oncology, Jamal Amel Hospital, Tyre, Lebanon.

14Department of Radiation Oncology, Hotel Dieu de France, Saint Joseph University Faculty of Medicine, Beirut, Lebanon.

15Division of Urology, Department of Surgery, Mount Lebanon Hospital, Beirut, Lebanon.

16Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon.

17Department of Surgery, Makassed Hospital, Beirut, Lebanon.

18Division of Hematology/Oncology, Department of Internal Medicine, Hammoud Hospital University Medical Center, Saida, Lebanon.

19Department of Radiation Oncology, Clemenceau Medical Center, Beirut, Lebanon.

20Division of Hematology/Oncology, Department of Internal Medicine, Sahel General Hospital, Beirut, Lebanon.

21Department of Surgery, Sahel General Hospital, Beirut, Lebanon.

22Middle East Tumor Institute, Beirut, Lebanon.

23Doctors Center Radiology, Beirut, Lebanon.

24Department of Urology, Saint Joseph University, Beirut, Lebanon.

25Division of Cancer Sciences, University of Manchester and the Christie, Manchester, UK.

26Department of Medical Oncology and Haematology, Cantonal Hospital Saint Gallen, University of Bern, Bern, Switzerland.

27Division of Urology, Department of Surgery, American University of Beirut Medical Center, Riad El Solh, 1107 2020, Beirut, Lebanon. rkhauli@aub.edu.lb.

PMID: 31297628

PMCID: PMC7064460

DOI: 10.1007/s00345-019-02872-x

Free PMC article

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.