Consensus Statement for Treating Metastatic Hormone Sensitive P Ca in developing Countries
In India, performing Radical Prostatectomies have increased exponentially with many centres practicing RARP, with some practicing Lap RP and few centres still adopting Open RP.
But majority of P Ca’s are seen in India are in advanced stages still. Metastatic hsP Ca is still the most prevalent form of presentation. Recent articles from the west indicate that there has been an increase in De Novo mP Ca in recent years, a paradox inspite of all available modalities at disposal to detect early P Ca.
There are numerous techniques for RARP now described with the most recent being ‘HOOD Technique’ proposed by Ashutosh Tewari et al. Recently there are articles suggesting the utility of ‘Perineal RARP’. This technique is gaining popularity as suggested by Volkan Tuğcu, Mithat Ekşi* et al (2020). Because of the proximity of the prostate to the perineal region and its extraperitoneal location, previous abdominal surgery does not provide any disadvantage. Also size of Prostate is no hindrance as is performing PLND.
Recently RP’s for even advanced disease are being considered with many articles addressing ‘Role of RP in Oligometastatic Disease’.
Many Drug regimes have developed since 2010, with LHRH agonist; later GnRH Antagonists coming to the fore along with Docetaxel were the treatments available for Metastatic P Ca. Bil. In Under developed countries due to non availability of recently introduced drugs and their unmanageable cost, Orchidectomy is the most preferred method for this situation of mP Ca. To use first line of Androgen Receptor Inhibitor, Bicalutamide, is considered an option along with Orchidectomy in Developing Countries. These issues as what ideal option that could be used in Under Developed, resource poor countries are well discussed in the ‘Consensus for Treatment of Metastatic Castration-Sensitive Prostate Cancer: Report from the First Global Prostate Cancer Consensus Conference for Developing Countries (PCCCDC)’ (PDF provided). The consensus study clearly states that many of the modalities now considered as ideal in developed countries are not possible in Developing Underprivileged countries. The consensus statement urges all to take these facts when considering implementing Treatments for Metastatic Hormone Sensitive P Ca.
I would appreciate all to give considerable importance to this Consensus statement when considering treatments for advance P Ca. The drawback of this consensus statement, however suitable it is for Indian Consumption, is that majority of the participants was Brazilians.
With warm Regards,