Maluf Fernando Cotait, Pereira Felipe Moraes Toledo, Serrano Uson Pedro Luiz, Bastos Diogo Assed, Rodrigues da Rosa Diogo Augusto, Wiermann Evanius Garcia, Schutz Fábio A, Kater Fábio Roberto, de Oliveira Fernando Nunes Galvão, Marques Monteiro Fernando Sabino, de Pádua Fernando Vidigal, Orlandi Francisco Javier, de Almeida Saito Helena Paes, Ayadi Mouna, Boghikian Pamela Salman, Kopp Ray Manneh, de Carvalho Ricardo Saraiva, de Fogace Rodrigo Nogueira, de Araújo Cavallero Sandro Roberto, Aguiar Sergio, Souza Vinicius Carreira, Sommer Silke Gillessen
Hospital Israelita Albert Einstein, São Paulo, Brazil.
Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
JCO Glob Oncol. 2021 Apr;7:550-558. doi: 10.1200/GO.20.00505.
International guideline recommendations may not always be extrapolated to developing countries where access to resources is limited. In metastatic castration-sensitive prostate cancer (mCSPC), there have been successful drug and imaging advancements that were addressed in the Prostate Cancer Consensus Conference for Developing Countries for best-practice and limited-resource scenarios.
A total of 24 out of 300 questions addressed staging, treatment, and follow-up for patients with mCSPC both in best-practice settings and resource-limited settings. Responses were compiled and presented in percentage of clinicians supporting each response. Questions had 4-8 options for response.
Recommendations for staging in mCSPC were split but there was consensus that chest x-ray, abdominal and pelvic computed tomography, and bone scan should be used where resources are limited. In both de novo and relapsed low-volume mCSPC, orchiectomy alone in limited resources was favored and in relapsed high-volume disease, androgen deprivation therapy plus docetaxel in limited resources and androgen deprivation therapy plus abiraterone in high-resource settings were consensus. A 3-weekly regimen of docetaxel was consensus among voters. When using abiraterone, a regimen of 1,000 mg plus prednisone 5 mg/d is optimal, but in limited-resource settings, half the panel agreed that abiraterone 250 mg with fatty foods plus prednisone 5 mg/d is 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.
The treatment recommendations for most topics addressed 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.
国际指南建议并非总能适用于资源获取有限的发展中国家。在转移性去势敏感性前列腺癌（mCSPC）中，已有成功的药物和影像学进展，这些在发展中国家前列腺癌共识会议中针对最佳实践和资源有限的情况进行了探讨。
在300个问题中，共有24个涉及mCSPC患者在最佳实践环境和资源有限环境下的分期、治疗及随访。对回复进行汇总，并以支持各回复的临床医生百分比呈现。问题有4 - 8个回复选项。
mCSPC分期的建议存在分歧，但一致认为在资源有限的情况下应使用胸部X光、腹部和盆腔计算机断层扫描以及骨扫描。在初发和复发的低容量mCSPC中，资源有限时单独行睾丸切除术更受青睐；在复发的高容量疾病中，资源有限时雄激素剥夺疗法联合多西他赛以及资源丰富时雄激素剥夺疗法联合阿比特龙达成了共识。多西他赛每3周一次的方案在投票者中达成了共识。使用阿比特龙时，1000毫克加泼尼松5毫克/天的方案是最佳的，但在资源有限的情况下，一半的专家小组同意阿比特龙250毫克与高脂食物同服加泼尼松5毫克/天是可以接受的。专家小组建议不使用抗破骨细胞靶向治疗来预防骨并发症。一致认为只有在前列腺特异性抗原升高或出现提示进展的症状时才应对接受全身治疗的患者进行监测。
最佳实践环境和资源有限环境下，大多数主题的治疗建议存在差异，这凸显了需要高质量证据来考虑有限资源对mCSPC管理的影响。
