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Treatment of the Hypogonadal Infertile Male-A Review

Ho CC, Tan HM

Sex Med Rev, 2013 May;1(1):42-49.
PMID: 27784559 DOI: 10.1002/smrj.4

INTRODUCTION: Testosterone treatment for hypogonadism is detrimental for men in reproductive age as it impairs spermatogenesis, and therefore affects fertility. It is, therefore, not indicated in men with hypogonadism and infertility.
AIM: The aim of this review is to analyze current data regarding options of treatment for men with hypogonadism and infertility.
MAIN OUTCOMES MEASURES: A comprehensive review of the current literature on management of infertility among hypogonadal men.
METHODS: A literature search using PubMed from 1980 to 2012 was done on articles published in the English language. The following medical subject heading terms were used: "infertility," "infertile," "hypogonadism;" "testosterone deficiency" and "men" or "male;" and "treatment" or "management."
RESULTS: The options for hypogonadal testicular failure are limited. Hormonal treatment is by and large ineffective. For secondary hypogonadism (hypogonadotropic/normogonadotropic hypogonadism), the options include gonadotropin-releasing hormone, human chorionic gonadotropin (hCG), human menopausal gonadotropin (hMG), follicle-stimulating hormone (FSH), and anti-estrogens and aromatase inhibitors. Dopamine antagonist is indicated for prolactinoma. Artificial reproductive technique is indicated for primary testicular failure and also when medical therapy fails.
CONCLUSION: The most suitable option with the current data available is hCG with or without hMG/FSH. Testosterone supplementation should be avoided, but if they are already on it, it is still possible for a return of normal sperm production within 1 year after discontinuing testosterone. Ho CCK and Tan HM. Treatment of the hypogonadal infertile male-A review. Sex Med Rev 2013;1:42-49.
Clinical recommendations on penile reconstructive and prosthetic surgery: a consensus statement from the Asia-Pacific Society of Sexual Medicine

Chung E, Moon DG, Hui J, Chang HC, Hakim L, Nagao K, et al.

Sex Med, 2023 Apr;11(2):qfad003.
PMID: 37056790 DOI: 10.1093/sexmed/qfad003

INTRODUCTION: Penile reconstructive and prosthetic surgery remains a highly specialized field where potential complications can be devastating, and unrealistic patient expectations can often be difficult to manage. Furthermore, surgical practice can vary depending on locoregional expertise and sociocultural factors.
METHODS: The Asia Pacific Society of Sexual Medicine (APSSM) panel of experts reviewed contemporary evidence regarding penile reconstructive and prosthetic surgery with an emphasis on key issues relevant to the Asia-Pacific (AP) region and developed a consensus statement and set of clinical practice recommendations on behalf of the APSSM. The Medline and EMBASE databases were searched using the following terms: "penile prosthesis implant," "Peyronie's disease," "penile lengthening," "penile augmentation," "penile enlargement," "buried penis," "penile disorders," "penile trauma," "transgender," and "penile reconstruction" between January 2001 and June 2022. A modified Delphi method was undertaken, and the panel evaluated, agreed, and provided consensus statements on clinically relevant penile reconstructive and prosthetic surgery, namely (1) penile prosthesis implantation, (2) Peyronie's disease, (3) penile trauma, (4) gender-affirming (phalloplasty) surgery, and (5) penile esthetic (length and/or girth enlargement) surgery.
MAIN OUTCOME MEASURES: Outcomes were specific statements and clinical recommendations according to the Oxford Centre for Evidence-Based Medicine, and if clinical evidence is lacking, a consensus agreement is adopted. The panel provided statements on clinical aspects of surgical management in penile reconstructive and prosthetic surgery.
RESULTS: There is a variation in surgical algorithms in patients based on sociocultural characteristics and the availability of local resources. Performing preoperative counseling and obtaining adequate informed consent are paramount and should be conducted to discuss various treatment options, including the pros and cons of each surgical intervention. Patients should be provided with information regarding potential complications related to surgery, and strict adherence to safe surgical principles, preoperative optimization of medical comorbidities and stringent postoperative care are important to improve patient satisfaction rates. For complex patients, surgical intervention should ideally be referred and performed by expert high-volume surgeons to maximize clinical outcomes.
CLINICAL IMPLICATIONS: Due to the uneven distribution of surgical access and expertise across the AP region, development of relevant comprehensive surgical protocols and regular training programs is desirable.
STRENGTHS AND LIMITATIONS: This consensus statement covers comprehensive penile reconstructive and prosthetic surgery topics and is endorsed by the APSSM. The variations in surgical algorithms and lack of sufficient high-level evidence in these areas could be stated as a limitation.
CONCLUSION: This APSSM consensus statement provides clinical recommendations on the surgical management of various penile reconstructive and prosthetic surgeries. The APSSM advocates for surgeons in AP to individualize surgical options based on patient condition(s) and needs, surgeon expertise, and local resources.
The influence of enclosure design on diurnal activity and stereotypic behaviour in captive Malayan Sun bears (Helarctos malayanus)

Tan HM, Ong SM, Langat G, Bahaman AR, Sharma RS, Sumita S

Res Vet Sci, 2013 Apr;94(2):228-39.
PMID: 23141171 DOI: 10.1016/j.rvsc.2012.09.024

The effect of enclosure design on diurnal activity and stereotypic behaviour was assessed in 17 adult Malayan Sun bears (Helarctos malayanus), kept either in barren indoor enclosures or relatively enriched outdoor enclosures. Locomotion was the most frequent activity observed in the indoor bears, followed by resting. In contrast, conspecifics housed outdoors spent most of the time resting. Eleven forms of stereotypic behaviours were recorded in the bears, with pacing being the most common. The frequency and repertoire of stereotypies were significantly higher in the indoor bears irrespective of enclosure size. Novel forms of locomotor (forward-reverse pacing) and oral (allo-sucking) stereotypies were recorded. Oral stereotypies were predominant in the bears housed indoors, while patrolling was confined to the outdoor bears. Enclosure complexity significantly influences activity budget and occurrence of stereotypic behaviours, highlighting the importance of appropriate enclosure design and enrichment for the welfare of captive bears.
A consensus on men's health status and policy in Asia: a Delphi survey

Teo CH, Ng CJ, Ho CC, Tan HM

Public Health, 2015 Jan;129(1):60-7.
PMID: 25542745 DOI: 10.1016/j.puhe.2014.11.009

OBJECTIVE: There is currently no documentation on the availability and implementation of policies related to men's health in Asia. This Delphi study aimed to achieve an Asian consensus on men's health policy based on the opinions and recommendations from men's health key opinion leaders.
STUDY DESIGN: A two-phase Delphi online survey was used to gather information from men's health stakeholders across Asian countries.
METHODS: All stakeholders were invited to participate in the survey through men's health conferences, personal contacts, recommendations from international men's health organizations and snowballing method. Stakeholders were asked about their concerns on 17 men's health key issues as well as their opinion on the availability and recommendations on men's health policies and programmes in their countries.
RESULTS: There were a total of 128 stakeholders (policy makers, clinicians, researchers and consumers), from 28 Asian countries, who responded in the survey. Up to 85% of stakeholders were concerned about various men's health issues in Asia and in their respective country, particularly in smoking, ischaemic heart disease and high blood pressure. There is a lack of men's health policies and programmes in Asia (availability = 11.6-43.5%) and up to 92.9% of stakeholders recommended that these should be developed.
CONCLUSIONS: These findings call for policy change and development, and more importantly a concerted effort to elevate men's health status in Asia.
Fulltext The status of men's health in Asia

Ng CJ, Teo CH, Ho CC, Tan WP, Tan HM

Prev Med, 2014 Oct;67:295-302.
PMID: 25117523 DOI: 10.1016/j.ypmed.2014.08.007

This study aims to compare health status and its risk factors between men and women who are from countries of different income status in Asia.
Fulltext Rapid birth-death evolution and positive selection in detoxification-type glutathione S-transferases in mammals

Tan HM, Low WY

PLoS One, 2018;13(12):e0209336.
PMID: 30586459 DOI: 10.1371/journal.pone.0209336

Glutathione S-Transferases (GSTs) are phase II detoxification enzymes that may have evolved in response to changes of environmental substrates. GST genes formed a multigene family and in mammals, there are six classes known as Alpha, Mu, Omega, Pi, Theta, and Zeta. Recent studies in phase I detoxification system specifically the cytochrome P450s provided a general explanation on why genes from a common origin such as those in a multigene family have both phylogenetically stable and unstable genes. Genes that participate in core functions of organisms such as development and physiology are stable whereas genes that play a role in detoxification are unstable and evolve in a process known as birth-death evolution, which is characterised by frequent gene gains and losses. The generality of the birth-death model at explaining the evolution of detoxification enzymes beyond the phase I enzyme has not been comprehensively explored. This work utilized 383 Gst genes and 300 pseudogenes across 22 mammalian species to study gene gains and losses. GSTs vary greatly in their phylogenetic stability despite their overall sequence similarity. Stable Gst genes from Omega and Zeta classes do not show fluctuation in gene numbers from human to opossum. These genes play a role in biosynthesis related functions. Unstable genes that include Alpha, Mu, Pi and Theta undergo frequent gene gain and loss in a process known as birth-death evolution. Gene members of these four classes are well known for their roles in detoxification. Our positive selection screen identified five positively selected sites in mouse GSTA3. Previous studies showed two of these sites (108H and 208E) were biochemically tested as important residues that conferred catalytic activity against the toxic aflatoxin B1-8,9-epoxide. The functional significance against aflatoxin of the remaining three positively selected sites warrant further investigation.
Science and society: Development of the Asian Men's Health Report: challenges and opportunities

Ng CJ, Teo CH, Ho CCK, Tan HM

Nat Rev Urol, 2017 Oct;14(10):630-636.
PMID: 28695921 DOI: 10.1038/nrurol.2017.93

Men have shorter life expectancy and higher mortality than women; however, only a few countries have dedicated men's health policies. Men's health reports can support the development of men's health policies. The 2013 Asian Men's Health Report (AMHR) systematically documents and compares the status of men's health across countries in Asia. The AMHR can be used as an exemplar to guide future men's health reports. The main challenges during creation of the AMHR were the lack of comprehensive health databases and the variety of data quality between countries. The AMHR revealed variations in mortality and morbidity across diseases, regions, and income groups, prompting a Delphi survey among men's health stakeholders to determine whether any dedicated men's health policies in Asia existed and to reach a consensus on the recommendations of men's health policies. The AMHR helped to promote men's health in Asia and across the world, generated research questions and collaborations, provided evidence to support development of men's health policies, identified the need to improve existing health databases, and developed a framework for the creation of other men's health reports.
ERG oncoprotein expression in prostate carcinoma patients of different ethnicities

Kelly GM, Kong YH, Dobi A, Srivastava S, Sesterhenn IA, Pathmanathan R, et al.

Molecular and clinical oncology, 2015 Jan;3(1):23-30.
PMID: 25469265

Overexpression of the erythroblast transformation-specific-related gene (ERG) oncoprotein due to transmembrane protease, serine 2 (TMPRSS2)-ERG fusion, the most prevalent genomic alteration in prostate cancer (CaP), is more frequently observed among Caucasian patients compared to patients of African or Asian descent. To the best of our knowledge, this is the first study to investigate the prevalence of ERG alterations in a multiethnic cohort of CaP patients. A total of 191 formalin-fixed paraffin-embedded sections of transrectal ultrasound-guided prostate biopsy specimens, collected from 120 patients treated at the Sime Darby Medical Centre, Subang Jaya, Malaysia, were analyzed for ERG protein expression by immunohistochemistry using the anti-ERG monoclonal antibody 9FY as a surrogate for the detection of ERG fusion events. The overall frequency of ERG protein expression in the population evaluated in this study was 39.2%. Although seemingly similar to rates reported in other Asian communities, the expression of ERG was distinct amongst different ethnic groups (P=0.004). Malaysian Indian (MI) patients exhibited exceedingly high expression of ERG in their tumors, almost doubling that of Malaysian Chinese (MC) patients, whereas ERG expression was very low amongst Malay patients (12.5%). When collectively analyzing data, we observed a significant correlation between younger patients and higher ERG expression (P=0.04). The prevalence of ERG expression was significantly different amongst CaP patients of different ethnicities. The higher number of ERG-expressing tumors among MI patients suggested that the TMPRSS2-ERG fusion may be particularly important in the pathogenesis of CaP amongst this group of patients. Furthermore, the more frequent expression of ERG among the younger patients analyzed suggested an involvement of ERG in the early onset of CaP. The results of this study underline the value of using ERG status to better understand the differences in the etiology of CaP initiation and progression between ethnic groups.
Fulltext Aging male symptoms scale (AMS) for health-related quality of life in aging men: translation and adaptation in Malay

Tan HM, Low WY, Tong SF, Hanif J, Appannah G, Lee VKM, et al.

Malaysian Journal of Public Health Medicine, 2015;15(2):17-23.
MyJurnal

The Aging Male Symptoms Scale (AMS) measures health-related quality of life in aging men. The objective of this paper is to describe the translation and validation of the AMS into Bahasa Melayu (BM). The original English version of the AMS was translated into BM by 2 translators to produce BM1 and BM2, and subsequently harmonized to produce BM3. Two other independent translators, blinded to the English version, back-translated BM3 to yield E2 and E3. All versions (BM1, BM2, BM3, E2, E3) were compared with the English version. The BM pre-final version was produced, and pre-tested in 8 participants. Proportion Agreement, Weighted Kappa, Spearman Rank Correlation Coefficient, and verbatim responses were used. The English and the BM versions showed excellent equivalence (weighted Kappa and Spearman Rank Coefficients, ranged from 0.72 to 1.00, and Proportion Agreement values ranged from 75.0% to 100%). In conclusion, the BM version of the AMS was successfully translated and adapted.
Fulltext Men's Health Index: a pragmatic approach to stratifying and optimizing men's health

Tan HM, Tan WP, Wong JH, Ho CC, Teo CH, Ng CJ

Korean J Urol, 2014 Nov;55(11):710-7.
PMID: 25405012 DOI: 10.4111/kju.2014.55.11.710

PURPOSE: The proposed Men's Health Index (MHI) aims to provide a practical and systematic framework for comprehensively assessing and stratifying older men with the intention of optimising their health and functional status.
MATERIALS AND METHODS: A literature search was conducted using PubMed from 1980 to 2012. We specifically looked for instruments which: assess men's health, frailty and fitness; predict life expectancy, mortality and morbidities. The instruments were assessed by the researchers who then agreed on the tools to be included in the MHI. When there was disagreements, the researchers discussed and reached a consensus guided by the principle that the MHI could be used in the primary care setting targetting men aged 55-65 years.
RESULTS: The instruments chosen include the Charlson's Combined Comorbidity-Age Index; the International Index of Erectile Function-5; the International Prostate Symptom Score; the Androgen Deficiency in Aging Male; the Survey of Health, Ageing and Retirement in Europe Frailty Instrument; the Sitting-Rising Test; the Senior Fitness Test; the Fitness Assessment Score; and the Depression Anxiety Stress Scale-21. A pilot test on eight men was carried out and showed that the men's health index is viable.
CONCLUSIONS: The concept of assessing, stratifying, and optimizing men's health should be incorporated into routine health care, and this can be implemented by using the MHI. This index is particularly useful to primary care physicians who are in a strategic position to engage men at the peri-retirement age in a conversation about their life goals based on their current and predicted health status.
KEYWORDS: Health status indicators; Men; Physical fitness; Retirement
Fulltext Managing the aging man in Asia: a review

Tong SF, Ho C, Tan HM

Int J Urol, 2011 Jan;18(1):32-42.
PMID: 20969645 DOI: 10.1111/j.1442-2042.2010.02652.x

The aging man is becoming a major burden to Asian countries because of the current poor health status of Asian men and the aging Asian population. Life expectancy at birth for men is shorter than women by an average of 4 years in Asian countries and major causes of death are cardiovascular disease, cancers, injuries and infections. However, there are considerable variations between Asian countries because of great disparity in socioeconomic status. Male-specific disorders, such as male sexual health and urological conditions, are other major health burdens because they have a great impact on men's quality of life. More importantly, many risk factors to the causes of mortality and morbidities, such as high-risk behavior and smoking, can be improved with health promotion and early intervention. The current evidence suggests that the poor health status of men is the result of their poor health care utilization, negative health-seeking behavior, the adverse social environment for men and gender-insensitive health care delivery. However, much evidence is still needed as Asian countries have great diversity in culture, societal values and men's needs. Asian time-tested wisdom on a balanced healthy lifestyle to longevity should be explored as potential men's health promotional programs. Taking into account Asian men's health-care needs, a gender-streamlined approach and man-friendly health care delivery should be on the national agenda in managing the aging man.
Fulltext Sex among Asian men and women: the Global Better Sex Survey in Asia

Tan HM, Marumo K, Yang DY, Hwang TI, Ong ML

Int J Urol, 2009 May;16(5):507-14; discussion 514-5.
PMID: 19467120 DOI: 10.1111/j.1442-2042.2009.02283.x

OBJECTIVES:
To explore by a pooled subanalysis of the Global Better Sex Survey sexual aspirations and unmet needs of men and women from Hong Kong, Indonesia, Japan, Malaysia, Singapore, South Korea, Taiwan, and Thailand.

METHODS:
To qualify, respondents must have had sexual intercourse at least once in the past 12 months. Women must have had heterosexual intercourse. Data were weighted by population size between countries.

RESULTS:
Of 3538 Asian respondents (1776 men and 1762 women), 52% were aged <40 years, 40% were aged 40-59 years, and 8% were aged >or=60 years. The majority were married or in a relationship. Men and women reported having sexual intercourse 5.1 and 4.0 times monthly, respectively. Attraction to partner, foreplay, intercourse, and achieving orgasm were important to most men and women. Two thirds were less than very satisfied with their sex life, and 36% of men were interested in improving sex. For a good sexual experience, the man's ability to get and maintain an erection and erection hardness were important to the majority of Asian men and women. Few respondents reported using a prescription erectile dysfunction medication, but many showed interest in using these medications to improve their sex lives. A comparison between individual countries suggests that attitudes about sex differ from country to country, and between men and women in each country.

CONCLUSIONS:
Sex is very important to Asian men and women, but many of them are not fully satisfied with their sex lives and want to improve them.
Fulltext Malaysian cultural differences in knowledge, attitudes and practices related to erectile dysfunction: focus group discussions

Low WY, Wong YL, Zulkifli SN, Tan HM

Int J Impot Res, 2002 Dec;14(6):440-5.
PMID: 12494275

This qualitative study aimed to examine cultural differences in knowledge, attitudes and practices related to erectile dysfunction (ED) utilizing focus group discussion. Six focus groups consisting of 66 men, 45-70-y-old were conducted-two Malay groups (n=18), two Chinese groups (n=25) and two Indian groups (n=23). Participants were purposely recruited from the general public on a voluntary basis with informed consent. Transcripts were analyzed using qualitative data analysis software ATLASti. The Malay and Chinese traditional remedies for preventing or treating ED are commonly recognized among all races. Many have a negative perception of someone with ED. Malay and Chinese men tended to blame their wife for their problem and thought that the problem might lead to extra-marital affairs, unlike the Indian men who attributed their condition to fate. Malays would prefer traditional medicine for the problem. The Chinese felt they would be more comfortable with a male doctor whilst this is not so with the Malays or Indians. Almost all prefer the doctor to initiate discussion on sexual issues related to their medical condition. There is a need for doctors to consider cultural perspectives in a multicultural society as a lack of understanding of this often contributes to an inadequate consultation.
New therapies for erectile dysfunction

Tan HM

Int. J. Androl., 2000;23 Suppl 2:87-8.
PMID: 10849506

The quest for improving and maintaining sexual function has been going on since time immemorial. The advent of an effective oral drug, sildenafil, has brought about unprecedented open discussion on male erectile dysfunction, and gas accelerated the pace of development of new therapies for erectile dysfunction. New knowledge in the physiology of sexual function has enabled researchers to target drug treatment at the whole network of the central nervous system and the numerous cascadic enzymatic reactions leading to relaxation of the corporal smooth muscle. One of the brightest potential applications of future molecular technology in the study of erectile dysfuction is in the utilization of gene therapy.
Self-perceived burden and its associations with health-related quality of life among urologic cancer patients

Ting CY, Teh GC, Yu KL, Alias H, Tan HM, Wong LP

Eur J Cancer Care (Engl), 2020 Jul;29(4):e13248.
PMID: 32495472 DOI: 10.1111/ecc.13248

OBJECTIVE: This study examined the prevalence of self-perceived burden (SPB) and its association with health-related quality of life (HRQoL) among urologic cancer patients.
METHODS: This was a prospective, cross-sectional study. A total of 429 respondents diagnosed with urologic cancers (prostate, bladder and renal cancer) from Sarawak General Hospital and Subang Jaya Medical Centre in Malaysia were interviewed by using a structured questionnaire. SPB and HRQoL were measured by the Self-perceived Burden Scale and the Functional Assessment of Cancer Therapy-General 7 Item Scale respectively.
RESULTS AND CONCLUSION: Self-perceived burden was experienced by 73.2% of the respondents. Respondents who had a lower education level, a monthly household income
Rise of herbal and traditional medicine in erectile dysfunction management

Ho CC, Tan HM

Curr Urol Rep, 2011 Dec;12(6):470-8.
PMID: 21948222 DOI: 10.1007/s11934-011-0217-x

Herbal medicine long has been used in the management of sexual dysfunction, including erectile dysfunction. Many patients have attested to the efficacy of this treatment. However, is it evidence-based medicine? Studies have been done on animal models, mainly in the laboratory. However, randomized controlled trials on humans are scarce. The only herbal medications that have been studied for erectile dysfunction are Panax ginseng, Butea superba, Epimedium herbs (icariin), Tribulus terrestris, Securidaca longipedunculata, Piper guineense, and yohimbine. Of these, only Panax ginseng, B. superb, and yohimbine have published studies done on humans. Unfortunately, these published trials on humans were not robust. Many herbal therapies appear to have potential benefits, and similarly, the health risks of various phytotherapeutic compounds need to be elucidated. Properly designed human trials should be worked out and encouraged to determine the efficacy and safety of potential phytotherapies.
Well-Differentiated Papillary Mesothelioma of the Tunica Vaginalis: Case Report and Systematic Review of Literature

Tan WK, Tan MY, Tan WS, Gan SC, Pathmanathan R, Tan HM, et al.

Clin Genitourin Cancer, 2016 Aug;14(4):e435-9.
PMID: 27067374 DOI: 10.1016/j.clgc.2016.03.007
Fulltext Relationships between cancer pattern, country income and geographical region in Asia

Ng CJ, Teo CH, Abdullah N, Tan WP, Tan HM

BMC Cancer, 2015;15:613.
PMID: 26335225 DOI: 10.1186/s12885-015-1615-0

BACKGROUND: Cancer incidence and mortality varies across region, sex and country's economic status. While most studies focused on global trends, this study aimed to describe and analyse cancer incidence and mortality in Asia, focusing on cancer site, sex, region and income status.
METHODS: Age-standardised incidence and mortality rates of cancer were extracted from the GLOBOCAN 2012 database. Cancer mortality to incidence ratios (MIRs) were calculated to represent cancer survival. The data were analysed based on the four regions in Asia and income.
RESULTS: Cancer incidence rate is lower in Asia compared to the West but for MIR, it is the reverse. In Asia, the most common cancers in men are lung, stomach, liver, colorectal and oesophageal cancers while the most common cancers in women are breast, lung, cervical, colorectal and stomach cancers. The MIRs are the highest in lung, liver and stomach cancers and the lowest in colorectal, breast and prostate cancers. Eastern and Western Asia have a higher incidence of cancer compared to South-Eastern and South-Central Asia but this pattern is the reverse for MIR. Cancer incidence rate increases with country income particularly in colorectal and breast cancers but the pattern is the opposite for MIR.
CONCLUSION: This study confirms that there is a wide variation in cancer incidence and mortality across Asia. This study is the first step towards documenting and explaining the changing cancer pattern in Asia in comparison to the rest of the world.
Fulltext A randomized, double-blind, placebo-controlled trial on the effect of long-acting testosterone treatment as assessed by the Aging Male Symptoms scale

Ho CC, Tong SF, Low WY, Ng CJ, Khoo EM, Lee VK, et al.

BJU Int, 2012 Jul;110(2):260-5.
PMID: 22093057 DOI: 10.1111/j.1464-410X.2011.10755.x

Study Type - Therapy (RCT). Level of Evidence 1b. What's known on the subject? and What does the study add? Testosterone deficiency syndrome can be treated with testosterone replacement in the form of injectable, transdermal, buccal and oral preparations. Long-acting i.m. testosterone undecanoate 1000 mg, which is given at 10-14 week intervals, has been shown to be adequate for sustaining normal testosterone levels in hypogonadal men. This study confirms that long-acting i.m. testosterone undecanoate is effective in improving the health-related quality of life in men with testosterone deficiency syndrome as assessed by the improvement in the Aging Male Symptoms scale. Testosterone treatment can be indicated in men who have poor health-related quality of life resulting from testosterone deficiency syndrome.
Fulltext Management of advanced prostate cancer in a middle-income country: real-world consideration of the Advanced Prostate Cancer Consensus Conference 2017

Saad M, Alip A, Lim J, Abdullah MM, Chong FLT, Chua CB, et al.

BJU Int, 2019 09;124(3):373-382.
PMID: 31077523 DOI: 10.1111/bju.14807

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.

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