Clinical and Histopathological Profile of Patients with Prostate Cancer in Kampala, Uganda

Abstract

Background: Prostate cancer (PCa) is the most prevalent malignancy among adult men with marked variation in mortality rate across regions globally. Uganda has the highest incidence of prostate cancer in East Africa. This study explored the spectrum of clinical and histopathological profile of patients diagnosed with PCa in Uganda between 2012 and 2014 at the Department of pathology, Makerere College of Health Sciences (MakCHS).
 Methods: This was a descriptive cross-sectional study aimed at providing an update of the spectrum of clinical and histopathological profile of patients with PC in Uganda. The study involved 211 cases diagnosed at the department of pathology between 2012 and 2014. After obtaining ethical clearance to carry out the study from the school of biomedical science; laboratory requisition forms collected, were used to extract the biodata information and also selection of the cases. Having selected the cases by using non-probability approach, tissue blocks were retrieved from the archive of the laboratory, sectioned and stained with haemtoxylin and eosin stains and cover-slipped before being examined by the investigator. Data generated were entered in the data collection form and analysis for frequency and descriptive statistics was done using SPSS version 16.0.
 Results: The study involved 211 patients with prostate cancer. The median age at diagnosis was 70 years and most of them, 82.9% had total PSA ≥ greater than 4.0ng/ml. Incomplete voiding of urine was the most common clinical feature which accounted for 43.6% and more than half, 61.2% of the patients had advanced disease. Almost half of the patients (44.6%) had Gleason score ≥ 8 and 47.9% of all the cases were in high risk group.
 Conclusions: Majority of patients with PCa in Uganda have raised pre-treatment total PSA and most of them are diagnosed with advanced disease. They also have high parameters of biologically aggressive prostate cancer such as Gleason score, lymphovascular invasion, perineural invasion and positive surgical margins.

Prevalence and Histological Patterns of Prostate Cancer Among Patients Presenting With Obstructive Lower Urinary Tract Symptoms at Mbarara Regional Referral Hospital

“…The above studies( [1,7,8,26] confirm with finding from other studies suggesting that Africans are likely to present with aggressive poorly differentiated prostate cancer unlike people from the white races [28], this could be is due to delayed hospital presentation however, African due to high testosterone levels and genetic predisposition are more likely to develop highly aggressive rapidly progressing prostate cancer [28].…”

“…A study done by Yahaya at Mulago Mulago National Refferal Hospital Uganda in 2019, also revealed that a significant proportion of his patients 44.6% had a Gleason score of ≥ 8 [8] however still lower than the percentage determined by our study A South African study published in 2014 revealed that black South Africans presented with significantly more aggressive disease defined by Gleason score >7 and poorly differentiated tumor grade within rural versus urban localities [26]. Okuku during his retrospective review Makerere found that majority of the specimens had high-risk disease with a Gleason score of 9 or 10 in 66.7% of the patients.…”

“…Usually early prostatic cancer is asymptomatic, as it progresses patients can develop, heamatura and heamatochezia and then in distant metastatic disease can a have a variety of symptom ranging from back pain, pathological fractures, and respiratory symptoms to severe aneamia [1]. Among all these symptoms LUTS are generally becoming more prevalent among patients with confirmed prostate cancer [1,[8][9][10]. This further asserts findings by Hamilton and sharp that locally advanced cancer can cause LUTS that are similar to those for benign prostatic hypertrophy [11] .In addition to the LUTS locally advanced prostate cancer can present with unique DRE findings like fixation of rectal skin, bleeding per rectum, increased nodularity.…”

Factors Influencing Uptake of Prostate Cancer Screening among Men Aged 40 Years and Above in Kazo Town Council, Kazo District, Uganda: A Cross‐Sectional Study

“…These findings are consistent with findings by Nakandi et al [ 12 ] who reported poor knowledge, misconceptions, and poor PCa screening among adult men aged 18-71 residing in Kampala. Low uptake of PCa screening has been linked to multiple factors and barriers, such as lack of knowledge, low socioeconomic status, attitudes, and beliefs [ 12 , 16 ], and increases the risk of advanced disease [ 36 ]. KI interviews supported this finding where issues such as late screening and fears about screening impacted the uptake of PCa screening in Kazo.…”