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

Abstract

Afro-Caribbean men have a higher risk of prostate cancer than any other population of men in the world. However, the Caribbean is composed of a heterogenous group of healthcare systems located on small islands which makes population-based studies difficult to conduct and interpret. The aim of this review is to compile previously published data on the state of prostate cancer in Caribbean men and to highlight potential healthcare needs that can be addressed by public health efforts. We reviewed three databases and identified relevant papers that were subsequently searched by the authors. Peer-reviewed studies published in the English language after 2010 with a focus on prostate cancer diagnosis, management, and outcomes of Caribbean men were prioritized. Afro-Caribbean men were found to have a higher incidence and mortality rate compared to their counterparts. Misperception about the disease, lack of regional guidelines, and poor access to care are compounding factors that result in worse outcomes for these men compared to high-income nations. Urologists and oncologists in the region, while well-trained, are limited in number and in most cases do not offer newer treatment modalities. Overall, only a few island nations have cancer registries, and there remains a significant need for more population-based studies to assess guideline adherence and outcomes. Until further research and investment in the region is made, the disparity between the care received by Afro-Caribbean men and their counterparts will likely remain.

Bayesian clustering of 109 worldwide countries according to the trend of prostate cancer mortality rates from 1990 to 2019

“…However, they are also highly ranked in terms of mortality rates for men with prostate cancer [ 23 , 24 ], which might be because of overdiagnosis of prostate cancer and high life expectancy in these countries. The high rates of prostate cancer mortality among Caribbean men are likely attributed to a combination of genetic predisposition and low socioeconomic status [ 25 ]. The second class, which included approximately 58% of the study sample, had the lowest mortality rate in the initial stage and an increasing trend over the study period.…”

“…This is thought to be due to a combination of genetic, environmental, and lifestyle factors. [ 25 , 27 ]. The class number four had the second highest prostate cancer mortality rate at the starting point of the study, followed by an almost stable pattern.…”

Trends in prostate cancer incidence among Black men in the Caribbean and the United States

“…Previous studies examining prostate cancer trends in the Caribbean showed increasing or constant high prostate cancer incidence rates up to 2008 10,22–24 . Further, there remains a lack of clear, consistent guidelines related to prostate cancer screening in the Caribbean 25 . However, it is possible that changes in screening recommendations may influence the practices of healthcare providers in other countries.…”

“…10,[22][23][24] Further, there remains a lack of clear, consistent guidelines related to prostate cancer screening in the Caribbean. 25 However, it is possible that changes in screening recommendations may influence the practices of healthcare providers in other countries. To our knowledge, there have been no studies assessing trends in prostate cancer incidence and advanced disease among men of the African Diaspora (United States and Caribbean) during the period of critical decisions about screening recommendations (since 2008).…”

Prostate Cancer in the Caribbean

“…Statistical analysis of the variables demonstrated a significant moderate correlation between PSA and Gleason score. Another study conducted in Jamaica by Shirley et al[43] investigated 99 PC patients' biopsy clinicopathology findings from 1993 to 1997 in the Pathology Department at the University of the West Indies (UWI). It was reported that the median PSA was 37 ng/ml, 63% of the patients clinically had stage T1 or T2 illness, and 60% of PC cases had a Gleason score of 8-10.…”