Management of patients with high-risk and advanced prostate cancer in the Middle East: resource-stratified consensus recommendations

World J Urol. 2020 Mar;38(3):681-693. doi: 10.1007/s00345-019-02872-x. Epub 2019 Jul 11.


Purpose: Prostate cancer care in the Middle East is highly variable and access to specialist multidisciplinary management is limited. Academic tertiary referral centers offer cutting-edge diagnosis and treatment; however, in many parts of the region, patients are managed by non-specialists with limited resources. Due to many factors including lack of awareness and lack of prostate-specific antigen (PSA) screening, a high percentage of men present with locally advanced and metastatic prostate cancer at diagnosis. The aim of these recommendations is to assist clinicians in managing patients with different levels of access to diagnostic and treatment modalities.

Methods: The first Advanced Prostate Cancer Consensus Conference (APCCC) satellite meeting for the Middle East was held in Beirut, Lebanon, November 2017. During this meeting a consortium of urologists, medical oncologists, radiation oncologist and imaging specialists practicing in Lebanon, Syria, Iraq, Kuwait and Saudi Arabia voted on a selection of consensus questions. An additional workshop to formulate resource-stratified consensus recommendations was held in March 2019.

Results: Variations in practice based on available resources have been proposed to form resource-stratified recommendations for imaging at diagnosis, initial management of localized prostate cancer requiring therapy, treatment of castration-sensitive/naïve advanced prostate cancer and treatment of castration-resistant prostate cancer.

Conclusion: This is the first regional consensus on prostate cancer management from the Middle East. The following recommendations will be useful to urologists and oncologists practicing in all areas with limited access to specialist multi-disciplinary teams, diagnostic modalities and treatment resources.

Keywords: Consensus; Middle East; Multidisciplinary; Prostate cancer; Resource-stratified recommendations.

Publication types

  • Consensus Development Conference

MeSH terms

  • Abiraterone Acetate / therapeutic use
  • Androgen Antagonists / therapeutic use*
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Agents, Hormonal / therapeutic use*
  • Benzamides
  • Biopsy, Large-Core Needle
  • Bone Neoplasms / secondary
  • Bone Neoplasms / therapy
  • Docetaxel / therapeutic use
  • Endosonography
  • Health Resources*
  • Health Services Accessibility*
  • Humans
  • Iraq
  • Kallikreins / metabolism
  • Kuwait
  • Lebanon
  • Lymph Node Excision
  • Magnetic Resonance Imaging
  • Male
  • Margins of Excision
  • Middle East
  • Neoplasm Metastasis
  • Nitriles
  • Phenylthiohydantoin / analogs & derivatives
  • Phenylthiohydantoin / therapeutic use
  • Positron-Emission Tomography
  • Prostate-Specific Antigen / metabolism
  • Prostatectomy*
  • Prostatic Neoplasms / diagnosis
  • Prostatic Neoplasms / epidemiology
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / therapy*
  • Prostatic Neoplasms, Castration-Resistant / diagnosis
  • Prostatic Neoplasms, Castration-Resistant / epidemiology
  • Prostatic Neoplasms, Castration-Resistant / pathology
  • Prostatic Neoplasms, Castration-Resistant / therapy
  • Radiotherapy, Adjuvant*
  • Risk
  • Salvage Therapy
  • Saudi Arabia
  • Syria


  • Androgen Antagonists
  • Antineoplastic Agents
  • Antineoplastic Agents, Hormonal
  • Benzamides
  • Nitriles
  • Docetaxel
  • Phenylthiohydantoin
  • enzalutamide
  • KLK3 protein, human
  • Kallikreins
  • Prostate-Specific Antigen
  • Abiraterone Acetate