Management of Advanced Prostate Cancer in the Middle East - Deborah Mukherji

December 6, 2019

Deborah Mukherji sits down with Carmel Pezaro at the Advanced Prostate Cancer Consensus Conference (APCCC 2019) to share her perspective on how prostate cancer care in the Middle East, specifically Lebanon, compares to the rest of the globe. They discuss the impact and the potential of genomic testing and the use of novel imaging, such as PSMA PET/CT relevant to work in the Middle East and in Lebanon.  They also explore how much we know about the outcomes for men from the Middle East in terms of the standard treatments. In conclusion, Dr. Mukherji shares her recommendations of the highest priorities in terms of moving forward with the management of men with prostate cancer in the Middle East.


Deborah Mukherji, MD, Assistant Professor of Medicine (Oncology), Medical Oncologist, American University of Beirut Medical Center, Beirut, Lebanon

Carmel Pezaro, BHB MBChB, FRACP, DMedSc, MHPE, Yorkshire Cancer Research (YCR) Senior Clinical Research Fellow, Academic Unit of Clinical Oncology, Department of Oncology & Metabolism, Weston Park Hospital, Sheffield, England, UK.

Read the Full Video Transcript

Carmel Pezaro: Okay. So, I'm really pleased to be joined by one of my very dear friends, Doctor Deborah Mukherji. Deborah is an Associate Professor of Medical Oncology working at the American University of Beirut in Lebanon. Debbie, thank you so much for joining me.

Deborah Mukherji: Thank you, Carmel. It's really nice to be here in Basel with you today.

Carmel Pezaro: So we've worked together for a long time now, but since we worked together, you've gone and you're setting up a really busy practice in Lebanon. So, tell me what's it like working in Lebanon and how do you find a meeting like this relevant to your practice?

Deborah Mukherji: So in the Middle East in general, and certainly in Lebanon, we have really high standards of care at academic medical centers that we do find that in a lot of peripheral hospitals we have prostate cancer managed by general urologists and oncologists who are not necessarily specialized in GU oncology.

So, we really felt that bringing the guidelines from this meeting or the guidance from this meeting, those controversial issues, which we may have trouble with, was really relevant to bring that data to our practitioners in the Middle East. And so, that's what we did. We set up a satellite meeting with Aurelius in Beirut and we formulated some resource stratified recommendations specifically for the Middle East region.

Carmel Pezaro: Yeah. It's fantastic. So, you were one of the regional APCCC meetings. So, how did your outcomes... What did you notice in terms of what differed in your outcomes compared to perhaps this kind of meeting outcome?

Deborah Mukherji: Certainly there were many, many different problems that we face in our region, specifically in regards to access to diagnostics, access to treatments, regards to financial coverage. There is not universal third party coverage in all areas. So, looking at things from a very practical and resource stratified view was really important to us for our regional consensus meeting.

So, we see a lot of locally advanced and metastatic disease in the region. We have limited prostate cancer, PSA screening. And some areas with very limited awareness. So, we felt that focusing on advanced and metastatic disease for the general urologist or general oncologist was a really important thing to focus on for our consensus meeting.

Carmel Pezaro: Fantastic. And in terms of, obviously, we're in day one of the 2019 meeting. So far, the very first session talked about the impact and the potential of genomic testing and the use of novel imaging, such as PSMA PET/CT. How are those things relevant to work in the Middle East and in Lebanon?

Deborah Mukherji: So, this is really important. Taking PSMA PET scans first of all, particularly in Lebanon, we have very, very easy access to PET PSMA. So, we have a lot of patients who are having PET PSMA scans for screening. Sometimes that may or may not be indicated and certainly is not included in guidelines at the moment. So, we still are learning how to use PET PSMA and where it's most important. In terms of germline and somatic testing, genetic testing. This is very limited in the Middle East region and we really have very limited data. And I think Professor Eeles very importantly showed that we do have differences in ethnicity.

So, I think getting data from the region, which is something that we are collaborating with the practical consortium on, is going to be really important for the future.

Carmel Pezaro: Absolutely. I was going to ask how much we know about the outcomes for men from the Middle East in terms of even the standard treatments that we have. What data are there?

Deborah Mukherji: So, we have very limited data and even the tumor registries in the region may only collect data on incidents rather than stage at diagnosis or outcome with treatments.

So, we are limited first of all from epidemiological data. And hopefully if we can collaborate in global programs to look at the management and outcome of patients with prostate cancer in various therapies, we may be finding regional and ethnic differences, which are important.

Carmel Pezaro: So at the moment, what do you see as the highest priorities in terms of moving forward with the management of men with prostate cancer in your region?

Deborah Mukherji: So, I think firstly is raising awareness and making sure that patients are being managed as far as possible in multidisciplinary teams. This is something that's not routine in the region. I think this really has the capacity to impact most on prostate cancer treatments. And the second one is really being able to stratify patients according to validated biomarkers or predicted biomarkers to make sure that we are selecting the right patients for the right treatments. So, this is something which we're all globally working on. But particularly in resource limited settings, this is even more important.

Carmel Pezaro: And actually relevant to all of us, no matter where we are. In terms of organizing the regional meeting, you obviously took a very big role in that and it was a lot of work. Would you have any suggestions for anyone who wants to organize a similar regional meeting following this APCCC?

Deborah Mukherji: I think it's a very enjoyable and positive experience. I think getting together all the members of the multidisciplinary team is important. So we involved our urologists, our pathologists, our radiation oncologist, radiologists. So, getting everyone involved to really have the benefit from the meeting and for that information to really disseminate throughout the community locally.

Carmel Pezaro: Wonderful. Well, thank you so much for your time and I hope you enjoy the rest of the meeting.

Deborah Mukherji: Thank you very much, Carmel.

Carmel Pezaro: Thank you.