2 UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE Introduction The majority of males in South Africa present with locally advanced and/or metastatic disease at 1,2 presentation. . Data used for recommendations is based on the denition of M1 disease as determined by radiographic imaging and bone scintigraphy due to the lack of data from studies 3 utilising newer more accurate imaging. Disease classication Metastatic disease that occurs after radical local treatment of the primary tumour is classied as 3 metachronous metastatic prostate cancer. Metastatic disease that is rst diagnosed in the advanced stage is classied as de novo or 3 synchronous prostate cancer. Patients with metachronous metastatic disease generally have a better prognosis than patients 3 with synchronous disease. SOUTH AFRICAN PROSTATE CANCER GUIDELINES Vs 04 OCTOBER 2024 METASTATIC HORMONE SENSITIVE PROSTATE CANCER (mHSPC) A full version of the guidelines is available on the Healthcare Professionals Section at: https://prostate-ca.co.za/ Panel Members: Prof. Shingai Mutambirwa - MBChB, MMed (Urology) Medunsa. Head of Urology Sefako Makgatho Health Sciences University. Dr. Lance Coetzee - MBChB (Pret.), MMed (Urol.), F.C.S (Urol.) SA, Fellow in Uro-Oncology (Duke Univ. USA). Urologist in private practice at the Pretoria Urology Institute. Prof. Ahmed Adam - MBChB, Dip PEC (SA), MMed FCS(SA) Urol. Academic Head: Division of Urology (Wits University),Clinical Head (Urology): CMJAH and Cluster Hospitals. Dr Pieter Spies - MBChB (US) MMed (Urol).Consultant Urologist, Tygerberg Hospital, University of Stellenbosch. Dr Jeff John - MBChB (UCT), FC Urol (SA), MMED (Urol). Head of the Division of Urology at Frere Hospital, East London. Dr. Sheynaz Bassa - MBChB (Univ of Natal), FC Rad (Onc) SA. Head of Department: Radiation Oncology Steve Biko Academic Hospital. Dr. Ingo de Muelenare - MBChB (Pret.), Dip ATLS (1994), FC Rad (Onc). SA., MMed (Rad.Onc) Wits, Radiation Oncologist in private practice in Johannesburg and Pretoria. Prof. Mike Sathekge - MBChB, MMed (Nuclear Medicine), Phd, MASSAF. Head of Department: Nuclear Medicine University of Pretoria. Dr Anthony Levy - MBBCh (WITS), BComm (Hons), FCRaD (UCT). Radiologist in private practice in Cape Town. Dr Devon Moodley - MMBch (Wits), FCP (SA) Medical oncologist in private practice in Johannesburg Dr Jireh Serfontein - MBChB (Pret.), Dip HIV Management, MMed Sexual Health (Univ. Sydney), Clinical head: My Sexual Health Pretoria. Dr Chantelle Scott – BSc Hons Genetics (Stell). MSc Med Genetic Counselling (UCT). PhD Human Genetics (Stell). Genetic Counsellor in private practice in Cape Town. Helen Shaw - Dip. in Physiotherapy (Pretoria). Physiotherapist specialising in pelvic dysfunctions in private practice in Cape Town. Daniel Mark Botha - BSc (Hons) Biokinetics. Biokineticist in private practice in Johannesburg. Metastatic PCa is classied as high or low volume and/or high or low risk based 3 on the CHAARTED and LATITUDE studies. High Low CHAARTED (volume) > 4 Bone metastases including > 1 outside the vertebral column or pelvis AND/OR Visceral metastasis (lymph nodes are not classied as visceral metastases) Not high LATITUDE (risk) > 2 high-risk features of: > 3 Bone metastasis Visceral metastasis > ISUP grade 4 Not high
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