Applicability of Western guidelines in low and middle-income countries for high risk, locally advanced and non-metastatic prostate cancer: from “minimal requirements” to optimal management in 2025

High-risk and locally advanced prostate cancer (PCa) is still a major concern in low- and middle-income countries (LMICs) where the limited availability of human and material resources do not allow implementation of the guidelines developed in high-income countries (HICs). In general, implementation of guidelines must take into account the differences in regional development, the availability of diagnostic tools, cost-effectiveness of treatments and the sociocultural context. In this report, we aim to focus on the applicability of the Western guidelines in LMICs for locally advanced and high-risk PCa and identify “minimal requirements” that should be offered to patients in resource-limited settings and “optimal care” which should be a realistic goal. This expert-based review, developed following the Expert International Oncology Meeting (EXIOME), provides context-adapted recommendations for the management of locally advanced and high-risk PCa in LMICs. This report summarises the EXIOME consensus for minimal requirements and optimal care for diagnosis, locoregional therapy and systemic management of locally advanced and high-risk PCa, oligometastatic and castration sensitive diseases. This consensus aims to support clinicians and policymakers in resource-limited settings by offering practical guidance aligned with global standards while acknowledging local resource and workforce constraints.