Metastatic castration resistant prostate cancer: current strategies of management in the Middle East

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

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.

Electronic supplementary material

The online version of this article (10.1007/s00345-019-02872-x) contains supplementary material, which is available to authorized users.

Cyclin-dependent kinase inhibitor 3 (CDKN3) plays a critical role in prostate cancer via regulating cell cycle and DNA replication signaling

Cyclin-dependent kinase inhibitor 3 (CDKN3) is proved to be associated with the progressing of many cancers. Whereas, its biological effects on prostate cancer (PC) are less understood. To investigate the functional mechanism of CDKN3 in PC, we examined the expression of CDKN3 in PC tissues and analyzed the disease free survival time of patients. We then transfected LNCaP and PC3 cells with siRNA-CDKN3 to silence CDKN3, and transfected 22RV1 and VCaP cells with full length CDKN3 cDNA for CDKN3 over-expression. Cell growth of these transfected cells were analyzed using CCK-8 assay. And transfected LNCaP and PC3 cells were further submitted to cell cycle, apoptosis, invasion and endogenous protein expression assays. We found that CDKN3 was highly expressed in PC and negatively correlated with disease relapse. And CDKN3 positively control the cell proliferation in prostate carcinoma cell lines. Knockdown of CDKN3 significantly promoted G1 phase arrest, elevated apoptosis rates, and suppressed cell invasion in both LNCaP and PC3 cells. Moreover, in vivo data showed that knockdown of CDKN3 expression dramatically inhibited the PC3 tumor growth in nude mouse model. Gene set enrichment analysis (GSEA) showed that cell cycle and DNA replication signaling were related with elevated CDKN3 expression. And results of western blot showed that the depletion of CDKN3 down-regulated the expression levels of cell cycle- and DNA replication-related proteins. In conclusion, our results highlight the importance of CDKN3 in PC and provide new insights into diagnostics and therapeutics of the PC.

Determinants of Behavioral Intentions to Screen for Prostate Cancer in Omani Men

Objective:

This study aimed at exploring the perceived barriers and intention to screen for prostate cancer (PCa).

Methods:

A survey questionnaire and a descriptive design were used to collect data from 129 Omani men above the age of 40 years. The questionnaire comprised the International Prostate Symptom Score (IPSS), barriers, and intention to screen scales. The participants were recruited from barbershops located in two cities of Oman.

Results:

The mean IPSS score was 8.31 ± 3.34 and the majority of participants had mild prostate cancer symptoms (60.4%). The others had moderate (28.7%) or severe symptoms (10.9%). Most men had low-to-moderate intention to screen using the method of digital rectal examination (DRE) (76%) and prostate-specific antigen test (PSA) (69.8%). The most common barriers to screening were fear of finding out something wrong (48.1%), not knowing what will be done during screening (54.3%), belief that PCa is not a serious disease (55.8%), and belief that DRE is embarrassing (56.6%). The significant determinants of intention to screen using DRE were perceived threat of the disease (P = 0.006) and past information from doctors that one has any prostate disease (P = 0.017). The determinants of intention to screen using PSA were perceived threat of the disease (P = 0.025), perceived general health (P = 0.047), and past information from doctors that one has any prostate disease (P = 0.017).

Conclusions:

The participants had diminutive intention to undergo PCa screening. Interventions aimed at enhancing PCa disease and risk awareness may help to reduce the barriers and increase PCa screening uptake.