Urological Society of India formulated guidelines for evaluation and management of prostate cancer

New Delhi: The Urological Society of India has formulated guidelines for the evaluation and management of prostate cancer, which is projected to claim almost double the lives of men in India by 2040 as compared to 2018.

The authors of the guidelines, which were recently published, believe that these are a guiding framework for a practicing urologist rather than being a rigid clinical pathway, and the final treatment should be individualised and be based on clinical judgment.

Experts say that overall, there is a rising trend in the incidence of prostate cancer globally. The increase in incidence has been projected to be as high as 100.9 per cent in Asian countries including India. Similarly, the number of prostate cancer deaths in India is also projected to double by 2040 compared to 2018. Prostate cancer, as recorded in the four metropolitan cities, is among the top three cancers diagnosed in men between 2009 and 2011.

As per the 2018 GLOBOCAN data, prostate cancer is the sixth most common cancer in the country, with an age-adjusted incidence rate of 10.2/100,000 and age-adjusted mortality rate of 4.2/100,000 population.

Screening and early detection were strongly recommended in guideline statements. Leading author Prof Anup Kumar from department of Urology and Renal Transplant at Safdarjung hospital said that personalised risk stratification may be undertaken for early detection on a case-to-case basis after the age of 50 when the life expectancy is more than 10–15 years and men at-risk must undergo both serum Prostate-Specific Antigen (PSA) test and digital rectal examination (DRE).

“Histological reporting (a report produced by a Pathologist describing the tissue taken at surgery) should follow recommendations by the International Society of Urological Pathology 2014 and the WHO 2016 classification,” recommended strongly by the panel of experts. Guidelines for treatment of low-risk, intermediate-risk, high-risk localised, locally advanced prostate cancer and castrate-resistant prostate cancer were formulated by the experts.

A strong recommendation was made by the panel for treatment of low risk prostate cancer offer radiotherapy to a suitable candidate who understands and accepts long-term oncological outcomes and side effects of the procedure and counsel patients about the possibility of requiring further treatment in future. Also, perform nerve-sparing radical prostatectomy with patient’s consent.

In case of treatment of high-risk localized prostate cancer, Prof Kumar said radical prostatectomy alone or as a part of a multimodality approach is a reasonable option for such patients and radiotherapy along with long-term androgen deprivation therapy (ADT) is a recommended therapeutic option. The guidelines stated that do not offer “antiandrogen monotherapy” in case of first line therapy in metastatic prostate cancer.

According to the experts, Kolkata has a crude incidence rate of 7.6/100000 population, which is higher than the other three metropolitan cities in the country. However, the age-adjusted rate (ARR) is highest in New Delhi (10.7/100,000 population), followed by Mumbai (7.8), Chennai (7.0), and Kolkata (6.9). Chennai (4.1) had the highest annual percentage change in the age-adjusted incidence rate of prostate cancer, followed by Bengaluru (3.36) and New Delhi (3.33).