High rates of advanced prostate cancer in the Middle East

Abstract

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.

Prostate cancer across four countries in the Middle East: a multi-centre, observational, retrospective and prognostic study

“…This is in line with findings from a recent publication which reported that a high percentage of men present with locally advanced and metastatic PC at diagnosis in the ME [ 22 ]. Additionally, a recent ME study, conducted at a large tertiary care centre that receives referrals for PC patients across the region, reported high proportions of patients diagnosed at stage III (Lebanon: 18%, Iraq: 25%, Syria: 33%) and IV (Lebanon: 19%, Iraq: 52%, Syria: 20%) [ 23 ]; it is of interest to note the variance in proportions by nationality – however, an important limitation of the study is that the vast majority of patients (71.4%) were Lebanese. The higher proportions of advanced PC stages reported in our study may partly be due to differences in the study populations, as the current study covered a broader range of populations across the ME.…”

Burden of prostate cancer in the Middle East: A comparative analysis based on global cancer observatory data

“…A confluence of unique circumstances and socio‐economic conditions within the Middle East could elucidate the paradox of higher prostate cancer mortality despite lower incidence rates in the region. One primary factor is the alarming rate of advanced prostate cancer diagnoses 7,9,18 . While the incidence of prostate cancer is increasing, data on the stage at diagnosis and treatment outcomes remain scarce, potentially leading to increased mortality rates.…”

“…A multitude of factors contribute to this knowledge gap including limited resources for comprehensive cancer registries, cultural barriers to healthcare access, and varied healthcare systems across the countries in this region 6–8 . The available small institutional data suggest a consistent increase in the incidence of prostate cancer in this region over the last decade 9 . This increasing trend, combined with a rapidly aging population, has raised serious concerns about the future healthcare burden and costs that the region will have to bear.…”

“… 6 , 7 , 8 The available small institutional data suggest a consistent increase in the incidence of prostate cancer in this region over the last decade. 9 This increasing trend, combined with a rapidly aging population, has raised serious concerns about the future healthcare burden and costs that the region will have to bear. The lack of robust epidemiological data in this setting poses substantial challenges in developing effective strategies for prostate cancer prevention, early detection, and management in the Middle East.…”

Targeting of H19/cell adhesion molecules circuitry by GSK-J4 epidrug inhibits metastatic progression in prostate cancer

“…Current therapies reside on radical prostatectomy or radiotherapy with good results regarding the 5-year survival rate for localized prostate cancer [ 3 ]. However, approximately one-third of patients developed metastatic disease and relapsed after local therapy, with bone as the most common site of metastasis, followed by lung and liver [ 4 – 7 ]. Standard treatments for advanced prostate cancer rely on androgen-deprivation therapies (ADT), paralleled by association with some recently discovered novel hormonal agents [ 8 ].…”