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 Caâ€™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 â€˜HOOD Techniqueâ€™ proposed by Ashutosh Tewari et al. Recently
there are articles suggesting the utility of â€˜Perineal RARPâ€™. This technique is gaining popularity as
suggested by Volkan TuÄŸcu,
Mithat EkÅŸi* 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 RPâ€™s for even advanced disease are being considered
with many articles addressing â€˜Role of RP in Oligometastatic Diseaseâ€™.
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 â€˜Consensus for Treatment of Metastatic
Castration-Sensitive Prostate Cancer: Report from the First Global Prostate
Cancer Consensus Conference for Developing Countries (PCCCDC)â€™ (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
With warm Regards,