Type of publication:

Conference abstract

Author(s):

Al-Samarat F.; *Alrawashdeh A.; Ibrahim R.; Khatib S.; Alrawashdeh K.; Salem A.;

Citation:

Radiotherapy and Oncology. Conference: ESTRO 2024. Glasgow United Kingdom. 194(Supplement 1) (pp S2796-S2798), 2024. Date of Publication: 01 May 2024.

Abstract:

Purpose/Objective: Prostate cancer is the second most common cancer and the fifth leading cause of cancer mortality in men worldwide (1). Prostate cancer is categorized into prognostic groups according to the results of prostate biopsy (Gleason score), prostate-specific antigen (PSA) at diagnosis and tumor stage (2). Treatment options are informed based on the cancer risk group and the patient's general health (2). The purpose of this study is to quantify current prostate cancer care practices in the Middle East and North Africa (MENA) to identify areas for improvement in the diagnosis and treatment while assessing how closely the current practices align with international practice guidelines Material/Methods: A Google questionnaire aligned with the European Society for Medical Oncology (ESMO) clinical practice guidelines for prostate cancer diagnosis, staging, and treatment was created and electronically distributed to healthcare professionals in the MENA region. The questionnaire contained inquiries about the approaches employed for prostate cancer assessment and treatment. It also assessed the accessibility of these methods in the participants' clinical settings. Result(s): Responses from 22 doctors across 11 different countries from the MENA region were received. These responses were from 9 (40.9%) medical oncologists, 4 (18.2%) radiation oncologists, 3 (13.6%) clinical oncologists, 1 (4.5%) surgical oncologist and 1 (4.5%) family doctor as well as 4 (18.2%) unknown specialties. Among these respondents, 9 (40.9%) doctors practiced in public hospitals, 8 (36.4%) in academic hospitals and 5 (22.7%) in private hospitals. Regarding diagnostic and staging methods utilized, the majority of respondents (N=15, 68.2%) reported the use of multiparametric MRI. A significant proportion of the respondents routinely perform transrectal ultrasound-guided biopsies (N=22, 90.9%), while 18 (81.8%) respondents reported employing bone scans for metastasis detection in patients with intermediate and high-risk prostate cancer. N=8 (36.4%) of the respondents use prostate-specific membrane antigen (PSMA) PET as a routine staging modality (Figure 1). For the treatment of localized intermediaterisk prostate cancer, 21 of 22 doctors (95.5%) offer at least one treatment that that is in agreement with international practice guidelines (radical prostatectomy +/- pelvic lymph node dissection, (N=8, 38.1%) or radiotherapy +/- androgen deprivation therapy (N=17, 80.9%). 3 out of 22 doctors (13.6%) offer at least one treatment that is not in agreement with international standards (e.g. androgen deprivation therapy alone). For localized highrisk prostate cancer, 20 out of 22 doctors (90.9%) offer at least one treatment that that is in agreement with international practice guidelines including radiotherapy with androgen deprivation therapy (N=14, 70%) or radiotherapy, androgen deprivation therapy and abiraterone/docetaxel (N=9, 45%), radical prostatectomy +/- pelvic lymph node dissection (N=2, 9%), 2 out of 22 (9%) offer at least one treatment that is not in agreement with international standards (androgen deprivation therapy alone (N=1, 16.6%) and brachytherapy alone (N=1, 16.6%)). Regarding the availability of treatment modalities, 20 (90.9%) respondents indicated access to radiotherapy, 4 (20%) have access to brachytherapy, 15 (75%) have access to advanced external beam radiotherapy techniques (volumetric modulated arc therapy, intensity-modulated radiotherapy) and 4 (18.2%) have access to robotic prostatectomy (Figure 2). Conclusion(s): The results demonstrated suboptimal use of multiparametric MRI at the time of initial diagnosis and staging of prostate cancer. Additionally, the results indicate suboptimal use of bone scans for staging of patients with intermediate-risk and high-risk disease. A minority of participants reported inappropriate management of localized intermediate- and high-risk prostate cancer. Furthermore, limited access to brachytherapy, robotic prostatectomy, and to a lesser extent advanced radiotherapy techniques was found. This study could guide future MENA prostate cancer policies and direct funds.

DOI: 10.1016/S0167-8140%2824%2901557-3