Prostate Cancer Characteristics

Abstract

Background: Prostate cancer, previously reported as relatively rare in Nigeria, is currently the leading cancer and leading cause of cancer-related death in men. Late presentation appears to persist despite higher incidence rates and instituted awareness programs. This study assesses current prostate cancer indices at presentation to a 3 rd tier referral hospital in South-east Nigeria and compares these indices with reported indices from previous decades. Materials and Methods: Retrospectively, the medical records of men presenting with histologically confirmed prostate cancer from January 2009 to April 2018 were reviewed. Age, spectrum and duration of clinical features, serum total prostate-specific antigen (tPSA), and prostate biopsy specimen Gleason Score (GS) at presentation were retrieved for the analysis using the SPSS software version 21. Obtained mean values and proportions were compared to reports from previous decades for observable shifts. Results: The medical records of 331 men 51–90 years of age (mean: 69.8 ± 8.0 years) were retrieved. Six (1.8%) men (median tPSA = 28.0 ng/ml; range 10.0–121.4 ng/ml) had screening-detected prostate cancer. About 72.0%, 52.0%, and 30.3% of men present with symptoms after 3 months, 6 months, and 12 months, respectively, and about 55.1% had other clinical features of disease progression beyond lower urinary tract symptoms. Symptom duration, serum tPSA (median 31.4 ng/ml; range 4.0–710.0 ng/ml), and % fPSA (median 20.6%; range 57.1%–8.6%) at presentation, as well as prevalent poorly-differentiated tumor (GS ≥7 [4 + 3] 62.2%) are yet to shift from reports from previous decades. Conclusions: Prostate cancer indices at presentation in South-eastern Nigeria, a resource-poor community in sub-Saharan Africa are yet to positively shift despite efforts at prostate cancer awareness.

Potential New Approaches for Prostate Cancer Management in Resource-Limited Countries in Africa

“…Digital rectal exams (DRE) are more widely possible, but these do not tend to be well-accepted by patients, are not very sensitive, and not very likely to detect potentially curable early-stage cancers. Consequently, prostate cancer is often not detected until the disease is at an advanced stage, when symptoms such as pain or urinary problems push patients to seek medical care [15][16][17][18][19][20]. Detecting metastatic diseases requires imaging, particularly bone scans, but this is costly, and the required equipment and expertise is not available in many resource-limited settings in SSA or other LLMICs.…”