Abstract
The Conference on Asian Trends in Prostate Cancer Hormone Therapy is an annual forum for Asian urologistsnow in its 5th year. The 2006 conference, held in Bali, Indonesia, was attended by 27 leading urologic oncologistsfrom China, Indonesia, Japan, Korea, Singapore, and Taiwan and featured a packed program of presentations anddiscussions on a wide range of topics such as relationships among clinicians and the newly opened Asia RegionalOffice for Cancer Control of the International Union Against Cancer (UICC), detection rates of prostate cancer bybiopsy in each of the 6 Asian countries, and favored treatment modalities for hormone-refractory prostate cancer(HRPC) in each country.The first session of the conference kicked off with a keynote lecture entitled “Activities of the UICC ARO”.UICC’s new office will be the nerve center for its activities in the Asia region. Along with the Asian Pacific Organizationfor Cancer Prevention (APOCP), UICC aims to shift the focus of attention to cancer control. As such APOCP'slong-running publication the APJCP is to be re-launched as the Asian Pacific Journal of Cancer Control. AlthoughUICC is primarily concerned with cancer, several risk factors for cancer are common also to other non-communicablediseases such as diabetes and heart disease, and an important strategy is to implement measures to control thesevarious pathologic conditions as a whole. Apart from contributing to an Asian prostate cancer registry the UICCAROwill provide training courses, working groups, and assistance in collecting and processing data.The keynote lecture was followed by a roundtable discussion on possible ways in which clinicians from eachAsian country can work with UICC. A number of suggestions were put forth including better registration,epidemiology research, possible implementation of UICC prostate cancer guidelines, early detection and screening,and roles of diet and phytotherapy. The underlying reasons for the large but dwindling difference in incidence ratesof prostate cancer in various regions of Asia should be studied while the opportunity lasts.Session 2 was devoted to 6 presentations on detection rates by biopsy in each country. Although biopsy is thegold standard for detecting prostate cancer in most areas, indications for conducting biopsy are different in eachcountry. For example, in Indonesia doctors may use PSAD 0.15 as the cutoff level. TRUS-guided biopsy is mostwidely used in Asian countries. Traditional sextant biopsy is often performed, although multiple-core biopsy iscommonly available and associated with better detection rates, especially in men with large prostate volume. PositiveDRE, high PSA, and older age were identified as factors associated with high biopsy detection rate, although elevatedPSA has limited specificity. First biopsy in men with elevated PSA had a positive detection rate of approximately30% in all countries. Community-based screening in some countries has an overall detection rate of approximately1%.The favorable treatment modality for HRPC was the subject of the final session. First priority for doctors in all6 countries is to maintain serum testosterone at castration level. Many therapeutic options are available, fromcytotoxic drugs to traditional herbal medicines Chemotherapeutic agents such as estramustine, docetaxel,cyclophosphamide, and mitoxantrone are often given to patients with HRPC although not all are available in everycountry. Prednisone and dexamethasone are used for secondary hormonal therapy. External beam radiotherapy,radioisotopic drugs such as strontium 89, and bisphosphonates are common choices to control bone pain.
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