Pathological upgrading and upstaging at radical prostatectomy in Jamaican men with low-risk prostate cancer

Abstract

Several studies suggest race-based health disparities in men with low-risk prostate cancer (PCa), with African American males having poorer oncological outcomes. We sought to determine the prevalence and predictors of pathological upgrading and upstaging in Jamaican men with low-risk PCa treated with radical prostatectomy (RP). Data on 141 men who met the National Comprehensive Cancer Network criteria for low-risk PCa and underwent RP at a single institution were reviewed. All men had a transrectal ultrasound-guided biopsy. Pre-operative clinical and final pathological data were obtained. Data were summarised as means and standard deviations or percentages as appropriate. Bivariate analyses such as independent samples t-tests and chi-square tables were conducted and logistic regression models were estimated to predict upgrading (>Gleason 6) and upstaging (p ≥ T3). The mean age was 59.5 ± 7.8 years with mean prostate specific antigen (PSA) of 6.6 ± 2 ng/mL. A total of 48.3% of men were upgraded and 11.4% were upstaged. Bivariate analyses indicated that PSA (p = 0.008) and percentage positive cores (p = 0.002) were associated with upgrading. PSA (p = 0.042) and percentage positive cores (p = 0.003) were significantly associated with upstaging. The odds of upgrading increased with increased PSA levels (OR 1.40, 95% CI 1.05-1.87, p = 0.021) or increased percentage positive cores (OR 8.27, 95% CI 2.19-31.16, p = 0.002). The odds of upstaging increased with increased PSA levels (OR 1.4, 95% CI 1.01-1.96, p = 0.046) and with increased percentages positive cores (OR 11.4; 95% CI 2.06-63.09, p = 0.005). Jamaican men with low-risk PCa are at high risk of pathological upgrading and upstaging at RP. These findings should be taken into consideration when discussing treatment options with these patients.

The safety of deferring operation for prostate carcinoma during the COVID-19 period

“…Various and controversial results such as black race, preoperative Psa value, the positive core rate, age, PSAD value, preoperative testosterone level and presence of metabolic syndrome were found. [18,[20][21][22][23] In our study, patients in all risk groups were evaluated in terms of the effect of time from biopsy to surgery on upstaging. However, no significant difference was found about upstaging in all risk groups between patients diagnosed and treated during the pre-COVID and COVID-19 pandemic period.…”

Prostate Cancer in the Caribbean: A Baseline Assessment of Current Practices and Potential Needs

“…9,10 In Jamaica, 304 men out of 100 000 are diagnosed annually, in Barbados 160 men out of 100 000, and in Tobago, nearly 10% of adult men were found to have prostate cancer annually. 5,6 Between 2008 and 2013, 292 men out of every 100 000 were diagnosed in Guadeloupe. 11 Reports from the French West-Indies, Cuba, and Puerto Rico corroborate these statistics while also highlighting an increased risk of diagnosis in men with less formal education and lower socioeconomic status—a contrast from the United States where less education is associated with less screening.…”

“…36 In contrast, in Jamaica patients often wait 1 to 2 years to receive EBRT due to a limited number of radiation facilities, limiting treatment options for men with localized prostate cancer to open prostatectomy or referral to another island. 5 During a similar period in Martinique, 370 consecutive cases receiving 125 I brachytherapy were reviewed and all patients were found to have been treated consistent with the French Urology Association guidelines with 12.7% receiving neoadjuvant hormone therapy. These patients were all evaluated with pretreatment endorectal MRI scans and bone scintigraphy, when appropriate.…”

“…In Jamaica, a 32-bed palliative care facility erected in 1963 remains the only inpatient option for patients with terminal cancer. 5 NGOs also provide community-based care in Guyana and Belize, though there is still an unmet need for more resources in the area.…”

“…The Caribbean has a high number of African descendants with reports of greater than 90% of the population originating from West Africa starting in the 17 th century with some immigrants also arriving from Central Africa (Congo). [4][5][6] International guidelines have attempted to provide guidance on risk stratification and treatment decisions though these are limited by variability in available resources, practice patterns and specialty clinics. 7 The National Comprehensive Cancer Network (NCCN) has published harmonized guidelines for the treatment of prostate cancer in Sub-Saharan Africa and the Caribbean with recommendations of lower-level care options to be considered when cost or travel for higher level-care is prohibitive.…”