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Management of advanced prostate cancer in a middle-income country: real-world consideration of the Advanced Prostate Cancer Consensus Conference 2017

Saad M 1 , Alip A 1 , Lim J 2 , Abdullah MM 3 , Chong FLT 4 , Chua CB 5 Show all authors , Ismail F 6 , Khong RK 5 , Lim CS 7 , Loh CS 5 , Malek R 8 , Mohd Ghani KA 9 , Md Noor I 10 , Md Yusoff NA 11 , Nasuha NA 12 , Razack A 2 , Soo Hoo HF 13 , Sundram M 11 , Tan HM 3 , Thiagarajan M 10 , Teh GC 14 , Voon PJ 15 , Ong TA 2

Affiliations 

  • 1 Department of Clinical Oncology, University of Malaya Medical Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 2 Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 3 Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
  • 4 Department of Radiotherapy and Oncology, Sabah Women and Children Hospital, Kota Kinabalu, Sabah, Malaysia
  • 5 Gleneagles Intan Medical Centre, Kuala Lumpur, Malaysia
  • 6 Department of Oncology and Radiotherapy, National University of Malaysia, Kuala Lumpur, Malaysia
  • 7 Department of Oncology and Radiotherapy, Sultan Ismail Hospital, Johor Bahru, Malaysia
  • 8 Department of Urology, Selayang Hospital, Selangor, Malaysia
  • 9 Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
  • 10 Department of Oncology and Radiotherapy, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
  • 11 Department of Urology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
  • 12 Department of Surgery, Raja Perempuan Zainab II Hospital, Kota Bharu, Kelantan, Malaysia
  • 13 Department of Oncology and Radiotherapy, Penang Hospital, Penang, Malaysia
  • 14 Department of Urology, Sarawak General Hospital, Sarawak, Malaysia
  • 15 Department of Radiotherapy, Oncology & Palliative Care, Sarawak General Hospital, Sarawak, Malaysia
BJU Int, 2019 09;124(3):373-382.
PMID: 31077523 DOI: 10.1111/bju.14807

Abstract

OBJECTIVE: To examine the results of the Malaysian Advanced Prostate Cancer Consensus Conference (MyAPCCC) 2018, held for assessing the generalizability of consensus reached at the Advanced Prostate Cancer Consensus Conference (APCCC 2017) to Malaysia, a middle-income country.

METHODS: Six key sections were chosen: (1) high-risk localized and locally advanced prostate cancer, (2) oligometastatic prostate cancer, (3) castration-naïve prostate cancer, (4) castrate resistant prostate cancer, (5) use of osteoclast-targeted therapy and (6) global access to prostate cancer drugs. There were 101 consensus questions, consisting of 91 questions from APCCC 2017 and 10 new questions from MyAPCCC 2018, selected and modified by the steering committee; of which, 23 questions were assessed in both ideal world and real-world settings. A panel of 22 experts, comprising of 11 urologists and 11 oncologists, voted on 101 predefined questions anonymously. Final voting results were compared with the APCCC 2017 outcomes.

RESULTS: Most voting results from the MyAPCCC 2018 were consistent with the APCCC 2017 outcomes. No consensus was achieved for controversial topics with little level I evidence, such as management of oligometastatic disease. No consensus was reached on using high-cost drugs in castration-naïve or castration-resistant metastatic prostate cancer in real-world settings. All panellists recommended using generic drugs when available.

CONCLUSIONS: The MyAPCCC 2018 voting results reflect the management of advanced prostate cancer in a middle-income country in a real-world setting. These results may serve as a guide for local clinical practices and highlight the financial challenges in modern healthcare.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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