Consensus on Screening, Diagnosis, and Staging Tools for Prostate Cancer in Developing Countries: A Report From the First Prostate Cancer Consensus Conference for Developing Countries (PCCCDC).

PURPOSE: To generate and present the survey results on critical issues relevant to screening, diagnosis, and staging tools for prostate cancer (PCa) focused on developing countries. METHODS: A total of 36 of 300 questions concern the main areas of interest of this paper: (1) screening, (2) diagnosis, and (3) staging for various risk levels of PCa in developing countries. A panel of 99 international multidisciplinary cancer experts voted on these questions to create recommendations for screening, diagnosing, and staging tools for PCa in areas of limited resources discussed in this manuscript. RESULTS: The panel voted publicly but anonymously on the predefined questions. Each question was deemed consensus if 75% or more of the full panel had selected a particular answer. These answers are based on panelist opinion not a literature review or meta-analysis. For questions that refer to an area of limited resources, the recommendations consider cost-effectiveness and the possible therapies with easier and greater access. Each question had five to seven relevant answers including two nonanswers. The results were tabulated in real time. CONCLUSION: The voting results and recommendations presented in this document can be used by physicians to support the screening, diagnosis, and staging of PCa in areas of limited resources. Individual clinical decision making should be supported by available data; however, as guidelines for screening, diagnosis, and staging of PCa in developing countries have not been developed, this document will serve as a point of reference when confronted with this disease.

Consensus on Prostate Cancer Treatment of Localized Disease With Very Low, Low, and Intermediate Risk: A Report From the First Prostate Cancer Consensus Conference for Developing Countries (PCCCDC).

PURPOSE: A group of international urology and medical oncology experts developed and completed a survey on prostate cancer (PCa) in developing countries. The results are reviewed and summarized, and recommendations on consensus statements for very low-, low-, and intermediate-risk PCa focused on developing countries were developed. METHODS: A panel of experts developed more than 300 survey questions of which 66 questions concern the principal areas of interest of this paper: very low, low, and intermediate risk of PCa in developing countries. A larger panel of 99 international multidisciplinary cancer experts voted on these questions to create the recommendations for treatment and follow-up for very low-, low-, and intermediate-risk PCa in areas of limited resources discussed in this manuscript. RESULTS: The panel voted publicly but anonymously on the predefined questions. Each question was deemed consensus if 75% or more of the full panel had selected a particular answer. These answers are based on panelist opinion not a literature review or meta-analysis. For questions that refer to an area of limited resources, the recommendations consider cost-effectiveness and the possible therapies with easier and greater access. Each question had five to seven relevant answers including two nonanswers. The results were tabulated in real time. CONCLUSION: The voting results and recommendations presented in this document can be used by physicians to support management for very low, low, and intermediate risk of PCa in areas of limited resources. Individual clinical decision making should be supported by available data; however, as guidelines for treatment for very low, low, and intermediate risk of PCa in developing countries have not been developed, this document will serve as a point of reference when confronted with this disease.

Robotic pyelolithotomy in a congenital pelvic kidney: side docking and robotic prostatectomy port - site approach.

INTRODUCTION AND OBJECTIVES: Ectopic pelvic kidneys with renal stones are challenging to treat. We report our experience in managing a case of ectopic pelvic kidney with a pelvic stone by robotic pyelolithotomy after failure of flexible ureteroscopy. MATERIALS AND METHODS: A 46-year old male with 2 months history of vague lower abdominal pain was found to have on Computed Tomography scan a left ectopic pelvic kidney with a 12mm stone in an anomalous renal pelvis. Flexible ureteroscopy failed to reach the stone twice and a 4.7 French ureteric stent was placed. RESULTS: Side docking was utilized with the patient in supine Trendelenburg position. Port placements were similar to robotic assisted laparoscopic prostatectomy. Docking time was 35 minutes and console time was 150 minutes. Multiple attempts failed to follow the course of the ureter to the renal pelvis. Subsequently the renal pelvis was directly opened through the mesocolon and a flexible cystoscope was used to basket the stone out. Estimated Blood Loss was < 100ml. The patient was discharged 2 days postoperatively. CONCLUSION: Robotic pyelolithotomy is safe and feasible for management of ectopic pelvic kidneys with pelvic stones. The use of flexible cystoscopy helped in localizing and extracting the stone in our case. Detailed understanding of patient's anatomy helps in the success of this procedure.