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Management of Advanced Prostate Cancer
Moderator: Dr. Ahmed Komen
- Prof. Asim Jamal Shaikh, Associate professor of Medicine, Consultant Medical Oncologist, Aga Khan Hospital, Nairobi
Prostate cancer is the most common cancer in Kenyan men, where 80% of patients present with advanced disease, encompassing a broad spectrum of diseases. The disease can be metastatic or non-metastatic. Metastatic hormone-sensitive prostate cancer is diagnosed by serum total PSA, a biopsy, conventional imaging (not readily available in Kenya), and Next-Generation Imaging (NGI). NGI is useful in grouping the patients as high/low risk/volume, depending on the disease burden. The Kenya national cancer screening guidelines guide the screening process, which should be individualized with consultations between the physician and the patient. Management of Metastatic hormone-sensitive prostate cancer is by androgen deprivation therapy (ADT), achieved through surgical or medical castration. ADT should be started within 3 months of diagnosis. Advanced prostate cancer in patients who are hormone-sensitive or with high risk/volume requires a combination of ADT and chemotherapy treatment for a better outcome, where disease volume or aggressiveness may help tailor treatment selection. The addition of surgery and /or radiotherapy to systemic treatment may have a role in the treatment of newly diagnosed metastatic disease. Radiation therapy has a significant role in palliative treatment settings. Management of other histological subtypes of prostate cancer requires a histology review since the different subtypes are treated differently. Some patients transform from adenocarcinoma to neuroendocrine subtype hence may require ADT. However, the degree of differentiation should be put into consideration. Prognosis is relatively poor, hence it’s important to perform a pathology review in case the patient is not responding well to treatment. Prostate treatment affects a patient’s sexuality, but ADT and vacuum-assisted devices help to restore sexual function. Considering the high cost of treatment, chemotherapy and the use of generic forms of the drugs may be quite affordable.