Management of Patients with High-Risk and Advanced Prostate Cancer in the Middle East: Resource-Stratified Consensus Recommendations

The 2017 Advanced Prostate Cancer Consensus Conference (APCCC) was held in St Gallen, Switzerland in March 2017 during which a panel of 60 international experts voted on 150 questions addressing controversial topics in prostate cancer management.¹ The first APCCC Satellite Meeting for the Middle East was held in Beirut, Lebanon in November 2017 in conjunction with the Middle East Prostate Cancer Consortium (MEPCC). This meeting comprised of urologists, medical oncologists, radiation oncologists and imaging specialists largely from Lebanon, Syria, and Iraq with expert urologists from Kuwait and Saudi Arabia joined by the co-chair of the APCCC Dr. Aurelius Omlin from St Gallen. During this satellite meeting, faculty members presented brief clinical updates with a focus on topics of particular relevance to the Middle East region and all attendees were asked to vote on a selection of the APCCC questions. Consensus was declared if ≥75% of participants who did not vote for “unqualified” or “abstain” and chose the same option.² The meeting was organized by the Continuing Medical Education office of the American University of Beirut and co-chaired by Dr. Deborah Mukherji (medical oncologist) and Dr. Raja Khauli (urologist and panel member for the APCCC 2017 meeting).

The manuscript published following the APCCC 2017 provides a guide for clinicians to assist in the discussions with patients as part of a multidisciplinary decision-making process particularly in areas lacking clear evidence from randomized clinical trials on which to base treatment recommendations.¹ Due to the rapid changes in prostate cancer management since this publication of the APCCC recommendations in 2017, an additional workshop was held in Beirut in March 2019 to update our resource-stratified consensus recommendations specifically for the Middle East using a modified-Delphi method. Resource- stratified recommendations are based on expert-opinion and structured in-line with a simplified version of the resource-stratification levels proposed by the Breast Health Global Initiative (BHGI) and adopted by the American Society of Clinical Oncology (ASCO).³ In a region lacking access to specialist multidisciplinary care in many areas, these recommendations are not designed to replace evidence-based guidelines however may assist in management decisions for patients with different levels of access to diagnostic and treatment modalities.

BTA 2019 middle east prostate

Written by: Deborah Mukherji, MBBS FRCP¹ and Raja Khauli, MD, FACS²
1. Associate Professor of Clinical Medicine, Department of Internal Medicine, Division of Hematology Oncology, American University of Beirut
2. Professor of Urology & Surgery Urologic Oncology and Robotics American University of Beirut-MED Adjunct Professor of Urology University of Massachusetts

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References:
1. Gillessen, Silke et al. 2018. "Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017". European Urology 73 (2): 178-211. Elsevier BV. doi:10.1016/j.eururo.2017.06.002.
2. Diamond IR et al (2014) Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol 67(4):401–409
3. Al-Sukhun S et al (2018) ASCO resource-stratified guidelines: methods and opportunities. J Glob Oncol 4:1–8

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