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30-40 41-50 51-60 >60
Male Female
Tier 1 city
Tier 2 city
Tier 3 city
< 5 years
5-10 years
11-20 years
>20 years
1-5
6-10
11-15
16-20
>20
10 % non-metastatic: 90% metastatic
20 % non-metastatic: 80% metastatic
30 % non-metastatic: 70% metastatic
40 % non-metastatic: 60% metastatic
50 % non-metastatic: 50% metastatic
Patients with cardiovascular co-morbidities
Patients with skeletal pain
Patients with bone pain
Patients with severe urinary obstruction
Paraplegic/Quadriplegic patients
Any Other
10-20%
21%-30%
31%-40%
41%-50%
>50%
50 % surgical castration: 50% medical castration
60 % surgical castration: 40% medical castration
70 % surgical castration: 30% medical castration
80 % surgical castration: 20% medical castration
LHRH Agonist
LHRH Antagonist (Injectable)
LHRH Antagonist (Oral)
Leuprolide acetate
Triptorelin
Goserelin
Yes
No
<5%
5-10%
11-15%
16-20%
>20%
PSA Progression
Radiographic progression
Clinical progression (Quality of life)
All the above
Refer the patient to Medical Oncologist
Initiate Abiraterone acetate + Prednisone
Initiate Enzalutamide
Abiraterone followed by Enzalutamide
Enzalutamide followed by Abiraterone