Worldwide prostate cancer is the second most common cancer and fifth in causing cancer mortality in men. It accounts for about 14.1% (more than 1.4 million) of all cancers in men and responsible for 6.8% (about 0.4 million) cancer deaths in the year 20201. In Pakistan, as per Globocan 2020, prostate cancer ranked 13th in new cases (around 4500 cases) and 16th in causing cancer mortality (about 2000 deaths)2. This discrepancy might be due to genetic heterogeneity of 220 million population or because of lack of central cancer registry. Over the past decade or so, there is a rapid change in the landscape of treatment of both localized and metastatic prostate cancer. Sophisticated surgical and radiation therapy techniques have reduced the rate of complications with improved quality of life3. Use of neoadjuvant, concurrent and adjuvant androgen deprivation therapy with radiation therapy in non-metastatic prostate cancer have shown to improve survival4. Novel anti-androgen agents (Abiraterone acetate5,6 Apalutamide7 and Enzalutamide8) and chemotherapy9 have also proved clear benefit in castrate sensitive prostate cancer. The arena of radiotheranostics10 has opened a new frontier in the etreatment of prostate cancer.Clinical features like serum age, ethnicity, PSA levels, Gleason's score11 and stage at presentation have been shown to effect the prognosis in prostate cancer. Molecular, and genetic factors have been investigated in predicting the outcome in prostate cancer though relatively few are routinely used.
This study will give insight into prostate cancer in our population and help us in making guidelines for better treatment with aim to design the Decision Support Platform (DSP) for artificial intelligence (AI)12.
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Pakistan – Globocan 2020 - https://gco.iarc.fr/today/data/factsheets/populations/586-pakistan-fact-sheets.pdf
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Muaddi H, Hafid ME, Choi WJ, Lillie E, de Mestral C, Nathens A, Stukel TA, Karanicolas PJ. Clinical Outcomes of Robotic Surgery Compared to Conventional Surgical Approaches (Laparoscopic or Open): A Systematic Overview of Reviews. Ann Surg. 2021 Mar;273(3):467-473. doi:10.1097/SLA.0000000000003915. PMID: 32398482.
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Boustead G, Edwards SJ. Systematic review of early vs deferred hormonal treatment of locally advanced prostate cancer: a meta-analysis of randomized controlled trials. BJU Int. 2007 Jun;99(6):1383-9. doi: 10.1111/j.1464-410X.2007.06802. x. Epub 2007 Mar 6. Erratum in: BJU Int. 2007 Jun;99(6):1390. PMID: 17346269.
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Karim Fizazi NamPhuong Tran, Luis Fein, Nobuaki Matsubara, Alfredo Rodriguez-Antolin, Boris Y Alekseev, Mustafa Özgüroğlu, Dingwei Ye, Susan Feyerabend, Andrew Protheroe, Peter De Porre, Thian Kheoh, Youn C Park, Mary B Todd, Kim N Chi: Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med 377 (4): 352-360, 2017.
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James ND, de Bono JS, Spears MR, Nicholas D. James, Ph.D., Johann S. de Bono, Ph.D., Melissa R. Spears, M.Sc., et al.: Abiraterone for Prostate Cancer Not Previously Treated with Hormone Therapy. N Engl J Med 377 (4): 338-351, 2017.
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Chi KN, Agarwal N, Bjartell A, Byung Ha Chung, Andrea J. Pereira de Santana Gomes, Robert Given, et al.: Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med 381 (1): 13-24, 2019.
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Davis ID, Martin AJ, Stockler MR, Stephen Begbie, Kim N. Chi, Simon Chowdhury, et al.: Enzalutamide with Standard First-Line Therapy in Metastatic Prostate Cancer. N Engl J Med 381 (2): 121-131, 2019.
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Kyriakopoulos CE, Chen YH, Carducci MA, Liu G, Jarrard DF, Hahn NM, et al.: Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer: Long-Term Survival Analysis of the Randomized Phase III E3805 CHAARTED Trial. J Clin Oncol 36 (11): 1080-1087, 2018.
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A. Oliver Sartor, Michael J. Morris, Richard Messman, Bernd J. Krause,: VISION: An International, Prospective, Open Label, Multicenter, Randomized Phase 3 Study of 177Lu-PSMA-617 in the Treatment of Patients With Progressive PSMA-positive Metastatic Castration-resistant Prostate Cancer (mCRPC), DOI: 10.1200/JCO.2021.39.15_suppl.LBA4 Journal of Clinical Oncology 39, no. 18_suppl
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D'Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA, Tomaszewski JE, Renshaw AA, Kaplan I, Beard CJ, Wein A.: Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA. 1998 Sep 16; 280(11):969-74.
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Mi Jung Rho, Jihwan Park, Hyong Woo Moon, Chanjung Lee, Sejin Nam, Dongbum Kim, et al. Dr. Answer AI for prostate cancer: clinical outcome prediction model and service. August 2020 PLOS ONE - Article
