Natural history of castration-resistant prostate cancer in sub-Saharan African black men: a single-centre study of Nigerian men

Abstract

PurposeNative sub-Saharan African black men (SSBM) are disproportionately impacted by higher stage and incurable forms of prostate cancer (PCa). This study evaluates the natural history and survival of a cohort of SSBM with castration-resistant prostate cancer (CRPC).MethodsA retrospective study of patients with CRPC as defined by the Prostate Cancer Working Group 2 managed at a centre in sub-Saharan Africa between January 2011 and December 2015 was conducted. The principal endpoint was overall survival (OS). Potential prognostic variables were evaluated using Cox proportional hazard regression models.ResultsA total of 48 patients were identified. Median (IQR) age and prostate-specific antigen (PSA) at diagnosis were 70 (64–74.5) years and 42 (8.0–123.6) ng/mL, respectively. Only 15 (31.3%) patients received docetaxel and one patient each received the novel drugs enzalutamide and abiraterone. Twenty-eight patients (58.3%) died during follow-up with a median OS of 11 (95% CI: 8–14) months. Docetaxel chemotherapy and ECOG performance status were found to be prognostic (docetaxel use: hazard ratio 0·25, 95% CI 0·10–0·67, p = 0·006; ECOG 0–2: 0·26, 0·11–0·62, p = 0·003).ConclusionThis study of SSBM with CRPC revealed a mainly unmodulated clinical course with poor access to active treatments and poor survival. Improving access to new active therapies would improve survival.

Clinicopathological presentation of patients with prostate cancer at Muhimbili National Hospital in Dar es Salaam, Tanzania

“…We report a high magnitude of CRPC with half of patients treated for advanced PC by androgen deprivation developing CRPC. This is similar to what others have reported [12]. It is important to identify patients with CRPC since there are targeted therapeutics which can improve both survival and quality of life [17][18].…”

“…Prostate cancer including CRPC is still a dilemma in low income countries given the morbidity and the cost needed to manage such patients [12]. Patients in sub-Saharan Africa have been shown to have poor access to active treatment of their CRPC [12].…”

“…Prostate cancer including CRPC is still a dilemma in low income countries given the morbidity and the cost needed to manage such patients [12]. Patients in sub-Saharan Africa have been shown to have poor access to active treatment of their CRPC [12]. It is expected that Tanzanian men, like other African men, will present with advanced stages and incurable forms of PC [13][14][15].…”

Gene Expression Profiling Analysis Reveals Putative Phytochemotherapeutic Target for Castration-Resistant Prostate Cancer

“…This state is referred to as castration-resistant prostate cancer (CRPC), and it is characterized by loss of ability to respond to androgen deprivation therapy and the recurrence of prostate cancer and subsequent metastasis (7). This recurrence of disease may occur in up to 40% of the patients (8, 9). For example, Bello (9) reported that 48 of 161 prostate cancer patients in Sub-Saharan Africa treated with androgen deprivation therapy developed CRPC, over a period of 4 years.…”

“…This recurrence of disease may occur in up to 40% of the patients (8, 9). For example, Bello (9) reported that 48 of 161 prostate cancer patients in Sub-Saharan Africa treated with androgen deprivation therapy developed CRPC, over a period of 4 years. Hence, CRPC continues to make prostate cancer the leading source of cancer mortality for men, particularly among the black race (4).…”