THB Sample Prostate Ca Screens prepared for NVS Team
ProstaCare India
Welcome Dr. Anand SharmaDemo launcher for patient file review and population analytics
Welcome Dr. Anand Sharma
Start the demo from a single landing page. Open today’s patient queue to access individual files in visit order, or switch to the population dashboard for cohort trends, care gaps, and protocol insights across hundreds of prostate cancer patients.
Professor & HODUrology & Radiation OncologyAIIMS New Delhi347 cohort records63 active care gap flags
Today At A Glance
Last Visit4Recently completed
Upcoming3Scheduled visits
Overdue2Requires immediate attn
Population Alerts7Protocol insight cards
Patient Files
Today’s visiting patients are sequenced by slot and status. Use search to jump directly to a patient by name or UHID.
Last Visit 4Upcoming 3Overdue 2
8 patients scheduled today
Viewer
Loading screen
The selected experience will open below.
ProstaCare India — Prostate Cancer Clinical Dashboard
THB Sample Prostate Ca Screens prepared for NVS Team
ProstaCare India
RKS
Ramesh Kumar Sharma
UHID: DL-2024-08742 · ABHA: 78-5432-1234-9876
Dr. Anand Sharma, MCh Urology
AIIMS New Delhi · Dept. of Urology & Renal Transplant
RKS
Ramesh Kumar SharmaHigh RiskHSPCCGHSADT Active
68 yrs · Male · Retired | UHID: DL-2024-08742 | ABHA: 78-5432-1234-9876 |
Registered: 14 Aug 2024 | AIIMS New Delhi, Dept. of Urology
Bone protection therapy not initiated — patient on ADT for 4 months (fracture risk elevated).
PSMA PET-CT not documented for high-risk staging workup.
View all nudges →
CT abdomen/pelvis: bilateral pelvic lymphadenopathy (cN1). Bone scan: not done (CGHS pre-auth pending). PSA: 31.4 ng/mL. Final stage: cT3bN1M0.
MAR 2024
MDT Tumour Board
5 March 2024 — AIIMS Oncology MDT
Plan: Long-course ADT (2–3 years) + definitive IMRT (prostate + whole pelvis, 78 Gy). ARSI intensification to be reviewed at 3-month mark. CGHS pre-auth initiated for RT.
APR 2024
ADT Initiated — Leuprolide 45 mg Depot
1 April 2024
Bicalutamide 50 mg OD started 7 days prior (testosterone flare cover). Leuprolide 45 mg depot (6-monthly) administered. Side effects: hot flushes, mild fatigue reported.
NOW AUG 24
Current Status — Awaiting RT Start
August 2024 · 4 months on ADT
PSA 42.6 ng/mL (pre-ADT baseline expected to decline). CGHS RT approval still pending. Bone scan not performed. No bone protection therapy initiated. PSMA PET-CT recommended but not done.
OCT 2024
Planned — RT Start (IMRT)
~1 October 2024 (planned, subject to CGHS approval)
Based on ICMR Consensus Guidelines (2022), Tata Memorial Centre Protocols, and EAU guidelines adapted for the Indian context by the Urological Society of India (USI) and Indian Society of Oncology (ISO).
Low RiskPSA <10 · Gleason 6 (3+3) · cT1–T2a▼
Preferred Options
Active Surveillance (AS) — preferred in fit patients <75 yrs; PSA q6m, DRE q12m, repeat biopsy at 12 months then q3–5 yr
Radical Prostatectomy (RP) — open retropubic or laparoscopic; robotic (RARP) at select centres (Tata Memorial, Apollo, AIIMS)
Low-dose rate (LDR) brachytherapy — available at AIIMS, TMC; outcomes equivalent to RP for low-risk
Acceptable Alternatives
EBRT alone (76–78 Gy / 39 fx or 60 Gy / 20 fx moderate hypofractionation) without ADT
SBRT 36.25 Gy / 5 fractions — at centres with IGRT capability (AIIMS, RGCI, Max)
Watchful waiting — acceptable for elderly (>75 yrs) or significant comorbidity (ECOG ≥2)
⚠ India context: AS compliance is challenging due to distance barriers and cost of surveillance biopsies (MRI-fusion). CGHS covers PSA monitoring. Brachytherapy seeds imported — availability and cost limit use outside metro centres.
RP + pelvic LND — consider adjuvant RT if pT3 / positive margins
EBRT + HDR brachytherapy boost — at TMC, AIIMS
⚠ India context: Short-course ADT (4–6 months) preferred over long-course for favourable-intermediate. Generic Leuprolide (Lupride, Sun Pharma) widely available. CGHS pre-authorisation required for Zoladex/Decapeptyl.
High / Very High RiskPSA >20 · Gleason ≥8 · cT3–T4 · cN1▼
Standard of Care
EBRT (prostate + whole pelvis) + Long-course ADT 24–36 months — class I recommendation
ADT intensification with ARSI: Abiraterone (generic) + Prednisone, Enzalutamide, or Apalutamide — recommended per STAMPEDE/ENZAMET/TITAN data
PSMA PET-CT for staging before RT planning — strongly recommended (available at AIIMS, TMC, SGPGI, ACTREC)
Surgery
RP + extended pelvic LND — selected cT3a cases, high-volume centres only
Multimodal approach: RP → adjuvant or salvage RT if pT3b / N+ / positive margins
Avoid surgery in cT4 / bulky cN1 — radiation + ADT preferred
Bone Health (Mandatory)
DEXA scan before or at ADT initiation
Calcium 500–1000 mg + Vitamin D3 800–1000 IU daily — all patients on ADT
Zoledronic acid 4 mg IV q6m OR Denosumab 60 mg SC q6m if osteopenia/osteoporosis on DEXA
Monitoring During ADT
PSA + Testosterone q3 months (first 2 years), then q6m
⚠ India context: Generic Abiraterone available (Sun Pharma, Cipla — ₹3,000–6,000/month vs ₹80,000+ originator). CGHS formulary now includes generic abiraterone in most states. Whole-pelvis RT requires CBCT/IGRT — available at govt centres. PSMA PET-CT: CGHS covers at empanelled centres; typical cost ₹18,000–25,000.
Adjuvant RT (pT3b, positive margins, pN+) + long ADT
Early salvage RT — at PSA ≥0.1 post-RP (preferred over adjuvant in many NCCN 2024 discussions)
Genomic Testing (NCCN 2024)
Germline testing: All high-risk, very high-risk, regional, and metastatic — Category 1
Somatic tumor testing: For metastatic — MSI/MMR, HRR panel
Imaging (NCCN 2024 — Updated)
PSMA PET-CT: Cat. 1 preferred over conventional imaging for initial staging in high-risk
Bone scan + CT remain acceptable if PSMA not available (Cat. 2A)
NCCN 2024 update: PSMA PET-CT elevated to Category 1 for high/very-high risk staging. Abiraterone + EBRT + ADT now firmly Category 1 for high-risk localised disease (per STAMPEDE arm G). Darolutamide added as new option for 2024.
Key areas where Indian clinical practice adapts, diverges, or aligns with NCCN 2024 recommendations — based on resource availability, healthcare financing (CGHS/PMJAY), and drug access in India.
ALIGNEDActive Surveillance criteria
Both recommend AS for very-low and low-risk disease. India follows same PSA/biopsy frequency schedule.
Both guidelines: mpMRI + targeted biopsy preferred for AS monitoring where available.
ALIGNEDLong-course ADT for High Risk
Both recommend 24–36 months ADT with EBRT for high-risk localised disease.
LHRH agonists (Leuprolide, Goserelin) are first-line in both. GnRH antagonists acceptable.
DIVERGESPSMA PET-CT access
NCCN 2024: Category 1 for high-risk. Indian guidelines: Recommended but access limited to AIIMS, TMC, SGPGI, ACTREC, and private tertiary.
India gap: ~54% of high-risk patients in this cohort did not receive PSMA PET-CT. Conventional staging (CT + bone scan) remains acceptable in resource-limited settings.
DIVERGESARSI intensification rates
NCCN: Abiraterone + EBRT + ADT is Category 1 for high-risk. India: Recommended but cost, CGHS formulary delays, and awareness limit adoption.
This cohort: 29% intensification vs benchmark >60%. Generic Abiraterone (Sun/Cipla) reduces cost barrier significantly.
DIVERGESGermline testing uptake
NCCN: Mandatory for all high-risk, regional, metastatic (Category 1). India: Recommended but testing infrastructure, cost (₹8,000–25,000), and referral pathways are gaps.
India needs national BRCA testing programme integrated into cancer care — currently fragmented across labs (MedGenome, Strand, ACTREC).
ALIGNEDmCRPC sequencing
Both recommend continued ADT (castrate testosterone), ARSI if naïve, then taxane. Lu-177 PSMA emerging in both.
BARC Mumbai and AIIMS New Delhi offer Lu-177 PSMA; NCCN Cat. 1 after ≥1 ARSI + taxane.
DIVERGESBone protection on ADT
Both recommend DEXA + bone-protective agents. India: Implementation severely lagging — 67% of ADT patients in this cohort have no bone protection.
CGHS covers Calcium + Vit D3 and Zoledronate. Protocol-level enforcement needed at AIIMS and affiliated centres.
ALIGNEDRT fractionation
Both endorse moderate hypofractionation (60 Gy/20 fx) as equivalent to conventional for intermediate-risk. SBRT acceptable at IGRT centres.
AIIMS, RGCI, ACTREC, and Max have IGRT/VMAT capability. Hypofractionation reduces treatment duration and CGHS burden.
EAU / NCCN Risk Groups
GroupCriteria (all must apply within group)
LowPSA <10 · Gleason 6 (3+3) · ISUP 1 · cT1–T2a
Int. Fav.1 risk factor only: PSA 10–20 OR Gleason 3+4 (ISUP 2) OR cT2b · <50% cores pos.
Int. Unfav.≥2 risk factors OR Gleason 4+3 (ISUP 3) OR >50% cores positive
All 347 registered patients — sortable, searchable registry
All (347)High / VH (142)Metastatic (31)On ADT (198)Active Surv. (42)
UHID
Name
Age
State
Stage
Risk
PSA (latest)
Gleason
Treatment
ADT
Coverage
Care Gap
Population Insights & Alerts
Auto-generated clinical insights — based on protocol deviations, care gaps & outcome signals
Critical · 42 patientsMajority of patients on long-term ADT have no bone protection
67% (42/63) of patients on ADT >3 months have not been prescribed zoledronic acid, denosumab, or even calcium + Vitamin D3. Fracture risk is substantially elevated. Recommend urgent protocol-level review — flag all ADT patients for DEXA + bone protection initiation at next visit. Bone health nurse specialist referral pathway may be needed.
Critical · 31 patientsHigh-risk patients staged without PSMA PET-CT — RT fields may be suboptimal
31 high-risk (cT3+/PSA >20/Gleason ≥8) patients received definitive RT without prior PSMA PET-CT. PSMA PET-CT changes nodal field and RT plan in ~40% of cases. This represents a significant quality-of-care concern — recommend retrospective review, and enforce PSMA PET-CT requirement in the staging protocol for all future high-risk patients at AIIMS, RGCI, and ACTREC. CGHS pre-auth for PSMA PET can be expedited.
Warning · 58 patientsARSI intensification rate well below international benchmarks
Only 29% of hormone-sensitive high-risk patients have been intensified with an ARSI (abiraterone, enzalutamide, apalutamide). International benchmark is >60%. Key barriers: cost, formulary delays, and physician awareness. Generic abiraterone availability makes this gap more actionable at the protocol level.
Warning · 24 patientsGermline testing not ordered despite family history or high-risk features
24 patients have documented breast/ovarian/pancreatic cancer family history or Gleason ≥9, and have not undergone BRCA1/2 germline testing. PARP inhibitor eligibility hinges on this result. Recommend an automated flag for family history + Gleason ≥8 patients.
Insight · 12 patientsCGHS approval delays causing mean 47-day treatment lag for RT
Analysis shows average 47-day delay from MDT decision to RT start due to CGHS pre-authorisation. Patients with stage cT3b+ experience the longest delays. Recommend pre-emptive documentation submission at MDT stage and a designated payer liaison workflow.
Insight · Cohort trendPSA nadir timing signals — proportion achieving PSA <0.2 at 12 months
Among patients with 12+ months follow-up post-RT + ADT, 62% achieved PSA <0.2 ng/mL at 12 months. Patients treated with whole-pelvic RT versus prostate-only RT showed stronger PSA control, supporting more aggressive nodal irradiation in cN1 patients.
Positive · ImprovingMDT review rate improved from 61% to 77% over past 12 months
Proportion of new diagnoses reviewed at MDT before treatment initiation rose from 61% to 77%. The additional weekly MDT slot appears to be the likely driver. Continue tracking against the 90%+ target.
Based on ICMR Consensus Guidelines (2022), Tata Memorial Centre Protocols, and EAU guidelines adapted for the Indian context by the Urological Society of India (USI) and Indian Society of Oncology (ISO).
Low RiskPSA <10 · Gleason 6 (3+3) · cT1–T2a▼
Preferred Options
Active Surveillance (AS) — preferred in fit patients <75 yrs; PSA q6m, DRE q12m, repeat biopsy at 12 months then q3–5 yr
Radical Prostatectomy (RP) — open retropubic or laparoscopic; robotic (RARP) at select centres (Tata Memorial, Apollo, AIIMS)
Low-dose rate (LDR) brachytherapy — available at AIIMS, TMC; outcomes equivalent to RP for low-risk
Acceptable Alternatives
EBRT alone (76–78 Gy / 39 fx or 60 Gy / 20 fx moderate hypofractionation) without ADT
SBRT 36.25 Gy / 5 fractions — at centres with IGRT capability (AIIMS, RGCI, Max)
Watchful waiting — acceptable for elderly (>75 yrs) or significant comorbidity (ECOG ≥2)
⚠ India context: AS compliance is challenging due to distance barriers and cost of surveillance biopsies (MRI-fusion). CGHS covers PSA monitoring. Brachytherapy seeds imported — availability and cost limit use outside metro centres.
RP + pelvic LND — consider adjuvant RT if pT3 / positive margins
EBRT + HDR brachytherapy boost — at TMC, AIIMS
⚠ India context: Short-course ADT (4–6 months) preferred over long-course for favourable-intermediate. Generic Leuprolide (Lupride, Sun Pharma) widely available. CGHS pre-authorisation required for Zoladex/Decapeptyl.
High / Very High RiskPSA >20 · Gleason ≥8 · cT3–T4 · cN1▼
Standard of Care
EBRT (prostate + whole pelvis) + Long-course ADT 24–36 months — class I recommendation
ADT intensification with ARSI: Abiraterone (generic) + Prednisone, Enzalutamide, or Apalutamide — recommended per STAMPEDE/ENZAMET/TITAN data
PSMA PET-CT for staging before RT planning — strongly recommended (available at AIIMS, TMC, SGPGI, ACTREC)
Surgery
RP + extended pelvic LND — selected cT3a cases, high-volume centres only
Multimodal approach: RP → adjuvant or salvage RT if pT3b / N+ / positive margins
Avoid surgery in cT4 / bulky cN1 — radiation + ADT preferred
Bone Health (Mandatory)
DEXA scan before or at ADT initiation
Calcium 500–1000 mg + Vitamin D3 800–1000 IU daily — all patients on ADT
Zoledronic acid 4 mg IV q6m OR Denosumab 60 mg SC q6m if osteopenia/osteoporosis on DEXA
Monitoring During ADT
PSA + Testosterone q3 months (first 2 years), then q6m
⚠ India context: Generic Abiraterone available (Sun Pharma, Cipla — ₹3,000–6,000/month vs ₹80,000+ originator). CGHS formulary now includes generic abiraterone in most states. Whole-pelvis RT requires CBCT/IGRT — available at govt centres. PSMA PET-CT: CGHS covers at empanelled centres; typical cost ₹18,000–25,000.
Adjuvant RT (pT3b, positive margins, pN+) + long ADT
Early salvage RT — at PSA ≥0.1 post-RP (preferred over adjuvant in many NCCN 2024 discussions)
Genomic Testing (NCCN 2024)
Germline testing: All high-risk, very high-risk, regional, and metastatic — Category 1
Somatic tumor testing: For metastatic — MSI/MMR, HRR panel
Imaging (NCCN 2024 — Updated)
PSMA PET-CT: Cat. 1 preferred over conventional imaging for initial staging in high-risk
Bone scan + CT remain acceptable if PSMA not available (Cat. 2A)
NCCN 2024 update: PSMA PET-CT elevated to Category 1 for high/very-high risk staging. Abiraterone + EBRT + ADT now firmly Category 1 for high-risk localised disease (per STAMPEDE arm G). Darolutamide added as new option for 2024.
Key areas where Indian clinical practice adapts, diverges, or aligns with NCCN 2024 recommendations — based on resource availability, healthcare financing (CGHS/PMJAY), and drug access in India.
ALIGNEDActive Surveillance criteria
Both recommend AS for very-low and low-risk disease. India follows same PSA/biopsy frequency schedule.
Both guidelines: mpMRI + targeted biopsy preferred for AS monitoring where available.
ALIGNEDLong-course ADT for High Risk
Both recommend 24–36 months ADT with EBRT for high-risk localised disease.
LHRH agonists (Leuprolide, Goserelin) are first-line in both. GnRH antagonists acceptable.
DIVERGESPSMA PET-CT access
NCCN 2024: Category 1 for high-risk. Indian guidelines: Recommended but access limited to AIIMS, TMC, SGPGI, ACTREC, and private tertiary.
India gap: ~54% of high-risk patients in this cohort did not receive PSMA PET-CT. Conventional staging (CT + bone scan) remains acceptable in resource-limited settings.
DIVERGESARSI intensification rates
NCCN: Abiraterone + EBRT + ADT is Category 1 for high-risk. India: Recommended but cost, CGHS formulary delays, and awareness limit adoption.
This cohort: 29% intensification vs benchmark >60%. Generic Abiraterone (Sun/Cipla) reduces cost barrier significantly.
DIVERGESGermline testing uptake
NCCN: Mandatory for all high-risk, regional, metastatic (Category 1). India: Recommended but testing infrastructure, cost (₹8,000–25,000), and referral pathways are gaps.
India needs national BRCA testing programme integrated into cancer care — currently fragmented across labs (MedGenome, Strand, ACTREC).
ALIGNEDmCRPC sequencing
Both recommend continued ADT (castrate testosterone), ARSI if naïve, then taxane. Lu-177 PSMA emerging in both.
BARC Mumbai and AIIMS New Delhi offer Lu-177 PSMA; NCCN Cat. 1 after ≥1 ARSI + taxane.
DIVERGESBone protection on ADT
Both recommend DEXA + bone-protective agents. India: Implementation severely lagging — 67% of ADT patients in this cohort have no bone protection.
CGHS covers Calcium + Vit D3 and Zoledronate. Protocol-level enforcement needed at AIIMS and affiliated centres.
ALIGNEDRT fractionation
Both endorse moderate hypofractionation (60 Gy/20 fx) as equivalent to conventional for intermediate-risk. SBRT acceptable at IGRT centres.
AIIMS, RGCI, ACTREC, and Max have IGRT/VMAT capability. Hypofractionation reduces treatment duration and CGHS burden.
EAU / NCCN Risk Groups
GroupCriteria (all must apply within group)
LowPSA <10 · Gleason 6 (3+3) · ISUP 1 · cT1–T2a
Int. Fav.1 risk factor only: PSA 10–20 OR Gleason 3+4 (ISUP 2) OR cT2b · <50% cores pos.
Int. Unfav.≥2 risk factors OR Gleason 4+3 (ISUP 3) OR >50% cores positive
