Global, Regional and National Burden of Prostate Malignancy, 1990 to 2015: Results from the Global Burden of Disease Study 2015 J Urol 1991224C12322018 [PubMed] [Google Scholar] 17. deprivation therapy plus docetaxel in limited resources and androgen deprivation therapy plus abiraterone in high-resource settings were consensus. A 3-weekly routine of docetaxel was consensus among voters. When using abiraterone, a routine of 1 1,000 mg plus prednisone 5 mg/d is definitely ideal, but in limited-resource settings, half the panel agreed that abiraterone 250 mg with fatty foods Gadodiamide (Omniscan) plus prednisone 5 mg/d is definitely suitable. The panel recommended against the use of osteoclast-targeted therapy to prevent osseous complications. There was consensus that monitoring of individuals undergoing systemic treatment should only be conducted in case of prostate-specific antigen elevation or progression-suggestive symptoms. Summary The treatment recommendations for most topics resolved differed between the best-practice establishing and resource-limited establishing, accentuating the need for high-quality evidence that contemplates the effect of limited resources on the management of mCSPC. Intro Prostate malignancy (PCa) is the second most frequently diagnosed malignancy in men worldwide, with an estimated 1.2 million new cases diagnosed in 2018, of which 80% presented with localized disease and 20% were diagnosed with an advanced or metastatic form of the disease.1 The burden of Gadodiamide (Omniscan) PCa is expected to increase to almost 2.3 million new cases and 740,000 deaths by 2040, because of growth and population ageing.1 The existing geographical variation of PCa trends and incidence rates worldwide largely displays the regional differences in the population distribution, with varying examples of genetic susceptibility and access to medical care and attention, especially in regards to the availability and use of prostate-specific antigen (PSA) screening.2-4 CONTEXT Key Objective How to find the very best strategies for treatment and follow-up of individuals with metastatic castration-sensitive prostate malignancy (mCSPC) in the context of limited resources? Knowledge Generated This manuscript summarizes a broad consensus of clinicians from different developing countries specialized on the management of prostate malignancy about optimized cost-effectives strategies in mCSPC scenario. The panel recommended more feasible staging tools such as the combination of chest x-ray, abdominal and pelvic computed tomography, and bone scan for initial approach of mCSPC and follow-up with prostate-specific antigen until medical or biochemical progression. Besides that, panelists proposed orchiectomy only to the treatment of low-volume mCSPC, and androgen deprivation therapy association with docetaxel or abiraterone for high-volume disease. Relevance This statement provides expert recommendations to help contextualized decision making in regions of the world where international recommendations may not always be extrapolated because of limited access to resources. The incidence of metastatic PCa at analysis varies widely across the globe, ranging from 5% of fresh PCa diagnoses in some Western countries to 60% in some areas in East Asia. Despite the relative stabilization of PCa incidence, the incidence of metastatic PCa continues to rise, with one study showing a 72% higher incidence of metastatic castration-sensitive prostate malignancy (mCSPC) in the United States over the past decade.5 It is unclear whether this boost is related to changes in screening recommendations; however, it proves to be concerning, given that mCSPC in generally considered to be incurable.6 Although localized PCa has a 5-12 months survival rate of 100%, mCSPC has a 5-12 months survival rate of 29.8%.7 Although most individuals in resource-abundant regions present with localized disease, individuals in resource-limited regions tend to present with advanced disease, reducing the possibilities of favorable treatment outcomes.8 mCSPC is used to describe the clinical situation whereby a patient with metastatic PCa has either never received treatment with androgen deprivation therapy (ADT) or exhibits ongoing level of sensitivity to ADT.9,10 Historically, ADT administered alone via surgical or medical castration has been the gold standard of treatment for individuals with mCSPC. Both methods are equally efficacious, and the improvement in disease progression with the use of ADT has been documented extensively (32% progression in 10 years 62% within the placebo group). Medical castration performed by bilateral orchiectomy is definitely a more cost-effective alternative to medical castration with luteinizing hormone-releasing hormone (LHRH) agonists or antagonists and may overcome healthcare access barriers and medication noncompliance that many developing countries face. However, the effect of ADT is definitely finite and resistance to ADT happens in most individuals, resulting in progression to castrate-resistant disease, which has a median overall survival (OS) of 1-2 years.11 The treatment landscape in.Associations may not relate to the subject matter of this manuscript. When using abiraterone, a regimen of 1 1,000 mg plus prednisone 5 mg/d is usually optimal, but in limited-resource settings, half the panel agreed that abiraterone 250 mg with fatty foods plus prednisone 5 mg/d is usually acceptable. The panel recommended against the use of osteoclast-targeted therapy to prevent osseous complications. There was consensus that monitoring of patients undergoing systemic treatment should only be conducted in case of prostate-specific antigen elevation or progression-suggestive symptoms. CONCLUSION The treatment recommendations for most topics resolved differed between the best-practice setting and resource-limited setting, accentuating the need for high-quality evidence that contemplates the effect of limited resources on the management of mCSPC. INTRODUCTION Prostate cancer (PCa) is the second most frequently diagnosed cancer in men worldwide, with an estimated 1.2 million new cases diagnosed in 2018, of which 80% presented with localized disease and Gadodiamide (Omniscan) 20% were diagnosed with an advanced or metastatic form of the disease.1 The burden of PCa is expected to increase to almost 2.3 million new cases and 740,000 deaths by 2040, because of growth and population aging.1 The existing geographical variation of PCa trends and incidence rates worldwide largely reflects the regional differences in the population distribution, with varying degrees of genetic susceptibility and access to SC35 medical care, especially in regards to the availability and use of prostate-specific antigen (PSA) screening.2-4 CONTEXT Key Objective How to find the very best strategies for treatment and follow-up of patients with metastatic castration-sensitive prostate cancer (mCSPC) in the context of limited resources? Knowledge Generated This manuscript summarizes a broad consensus of clinicians from different developing countries specialized on the management of prostate cancer about optimized cost-effectives strategies in mCSPC scenario. The panel recommended more feasible staging tools such as the combination of chest x-ray, abdominal and pelvic computed tomography, and bone scan for initial approach of mCSPC and follow-up with prostate-specific antigen until clinical or biochemical progression. Besides that, panelists proposed orchiectomy alone to the treatment of low-volume mCSPC, and androgen deprivation therapy association with docetaxel or abiraterone for high-volume disease. Relevance This report provides expert recommendations to help contextualized decision making in regions of the world where international guidelines may not always be extrapolated because of limited access to resources. The incidence of metastatic PCa at diagnosis varies widely across the globe, ranging from 5% of new PCa diagnoses in some Western countries to 60% in some areas in East Asia. Despite the relative stabilization of PCa incidence, the incidence of metastatic PCa continues to rise, with one study showing a 72% higher incidence of metastatic castration-sensitive prostate cancer (mCSPC) in the United States over the past decade.5 It is unclear whether this increase is related to changes in screening recommendations; however, it proves to be concerning, given that mCSPC in generally considered to be incurable.6 Although localized PCa has a 5-12 months survival rate of 100%, mCSPC has a 5-12 months survival rate of 29.8%.7 Although most patients in resource-abundant regions present with localized disease, patients in resource-limited regions tend to present with advanced disease, decreasing the possibilities of favorable treatment outcomes.8 mCSPC is used to describe the clinical situation whereby a patient with metastatic PCa has either never received treatment with androgen deprivation therapy (ADT) or exhibits ongoing sensitivity to ADT.9,10 Historically, ADT administered alone via surgical or medical castration has been the gold standard of treatment for patients with mCSPC. Both methods are equally efficacious, and the improvement in disease progression with the use of ADT has been documented extensively (32% progression in 10 years 62% around the placebo group). Surgical castration performed by bilateral orchiectomy is usually a more cost-effective alternative to medical castration with luteinizing hormone-releasing hormone (LHRH) agonists or.