e552 Background: Current data suggest that prostate cancer incidence is increasing in the Middle East and North Africa (MENA) region however remains significantly lower than the United States and Europe. No data are available regarding stage at diagnosis or treatment. SEER data from the US suggest that only 4% of patients present with metastatic disease. We hypothesized that rates of presentation with stage 4 disease are significantly higher in the MENA region. Methods: After IRB approval, a review of prostate cancer cases presenting to the leading tertiary referral center in Lebanon from January 2010 to July 2015 was undertaken. From September 2014 these data were collected prospectively. The American University of Beirut Medical Center sees approximately one third of all cancer cases in the country and is a major referral center for Syria and Iraq. Results: 582 cases were identified, median age at diagnosis was 68 (range 43-97); median PSA at diagnosis was 10.2ng/ml (range 2.3 – 3490), median Gleason score was 7. 480 patients had staging data available; 77.4% (449) presented with organ-confined disease, 22.6% (136) presented with stage 4 disease at diagnosis. 12% of this cohort were from Iraq, 57.6% presenting with stage 4 disease. Increasing age correlated with higher stage at presentation in this cohort. In patients presenting with PSA > 20, 62.3% were found to have stage 4 disease. Conclusions: This is the first report of prostate cancer stage at diagnosis from a large cohort of patients from the Middle East showing a median age at diagnosis of 68 and 22.6% presenting with stage 4 disease. These data highlight the importance of multi-disciplinary management and health-care system planning for the rising burden of prostate cancer affecting the MENA population.

Objectives: Prostate cancer incidence is increasing in the Middle East (ME); however, the data of stage at the diagnosis and treatment outcomes are lacking. In developed countries, the incidence of de novo metastatic prostate cancer ranges between 4% and 14%. We hypothesized that the rates of presentation with advanced disease are significantly higher in the ME based on clinical observation. This study aims to examine the stage at the presentation of patients with prostate cancer at a large tertiary center in the ME. Methods: After Institutional Review Board approval, we identified the patients diagnosed with prostate adenocarcinoma and presented to a tertiary care center between January 2010 and July 2015. Clinical, demographic, and pathological characteristics were abstracted. Patients with advanced disease were stratified according to tumor volume based on definitions from practice changing clinical trials. Descriptive and Kaplan–Meier survival analysis was used. Results: A total of 559 patients were identified, with a median age at the diagnosis of 65 years and an age range of 39–94 years. Median prostate-specific antigen (PSA) at the presentation was 10 ng/ml, and almost a quarter of the men (23%) presented with metastatic disease. The most common site of metastasis was the bone (34/89, 38%). High-volume metastasis was present in 30.3%, 9%, and 5.2% of the cohort based on STAMPEDE, CHAARTED, and LATITUDE trial criteria, respectively. Conclusion: This is the first report showing the high proportion of men from ME presenting with de novo metastasis. This could be due to many factors, including the highly variable access to specialist multidisciplinary management, lack of awareness, and lack of PSA screening in the region. There is a clear need to raise the awareness about prostate cancer screening and early detection and to address the rising burden of advanced prostate cancer affecting men in the ME region.

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