Prostate Cancer Burden at the Uganda Cancer Institute

Abstract

PurposeIn Uganda, the incidence of prostate cancer is increasing at a rate of 5.2% annually. Data describing presentation and outcomes for patients with prostate cancer are lacking.MethodsA retrospective review of medical records for men with histologically confirmed prostate cancer at the Uganda Cancer Institute (UCI) from January 1 to December 17, 2012, was performed.ResultsOur sample included 182 men whose mean age was 69.5 years (standard deviation, 9.0 years). Patients who presented to the UCI had lower urinary tract symptoms (73%; n = 131), bone pain (18%; n = 32), increased prostate-specific antigen (PSA; 3%; n = 5), and other symptoms (6%; n = 11). Median baseline PSA was 91.3 ng/mL (interquartile range, 19.5-311.3 ng/mL), and 51.1% of the patients (n = 92) had a PSA value above 100 ng/mL. Gleason score was 9 or 10 in 66.7% of the patients (n = 120). Ninety percent (n = 136) had stage IV disease, and metastatic sites included bone (73%; n = 102), viscera (21%; n = 29), and lymph nodes (4%; n = 5). Spinal cord compression occurred in 30.9% (n = 55), and 5.6% (n = 10) experienced a fracture. A total of 14.9% (n = 27) underwent prostatectomy, and 17.7% (n = 32) received radiotherapy. Gonadotropin-releasing hormone agonist was given to 45.3% (n = 82), 29.2% (n = 53) received diethylstilbestrol, and 26% (n = 47) underwent orchiectomy. Chemotherapy was administered to 21.6% (n = 39), and 52.5% (n = 95) received bisphosphonates. During the 12 months of study, 23.8% of the men (n = 43) died, and 54.4% (n = 98) were lost to follow-up.ConclusionUCI patients commonly present with high PSA, aggressive Gleason scores, and stage IV disease. The primary treatments are hormonal manipulation and chemotherapy. Almost 25% of patients succumb within a year of presentation, and a large number of patients are lost to follow-up.

Late Diagnosis among patients with Prostate Cancer at the Uganda Cancer Institute: A retrospective cohort study

“…Related studies in Uganda and other developing countries have found other possible causes of patient and health system delays to include patients non-adherence to the recommended investigations, referral complexity as cancer investigations are done from different locations and lack of large scale population-based prostate cancer screening (5,10,19). Indeed, in our cohort all patients were assessed for prostate cancer after developing symptoms.…”

“…In Uganda prostate cancer has been increasing at a rate of 5.2% annually, making it the most rapidly increasing cancer in the country and in sub-Saharan Africa (5). Despite the increase in incidence, approximately 90% of prostate cancer patients are not aware of the disease and as a result they do not take early urinary symptoms seriously hence they are diagnosed late with very advanced disease in stage IV presenting with incurable tumors (5-7).…”

Clinical characteristics and primary management of patients diagnosed with prostate cancer between 2015 and 2019 at the Uganda Cancer Institute

“…The Globocan report of 2018 indicates that Uganda had 2086 (6.4%) incident cases of prostate cancer, and this was the second most common cancer in males [ 1 ]. In Uganda, more than 90% of all the prostate cancer cases seen at the UCI are referrals from the region, and these often present with advanced disease [ 10 ]. Few studies in sub-Saharan Africa have described the clinical and demographic patterns of prostate cancer patients.…”

Late Diagnosis among patients with Prostate Cancer at the Uganda Cancer Institute: A retrospective cohort study.

“…In Uganda prostate cancer has been increasing at a rate of 5.2% annually, making it the most rapidly increasing cancer in the country and in sub-Saharan Africa (5). Despite the increase in incidence, approximately 90% of prostate cancer patients are not aware of the disease and as a result they do not take early urinary symptoms seriously hence they are diagnosed late with very advanced disease in stage IV presenting with incurable tumors (5)(6)(7). Late diagnosis limits treatment options, increases mortality and leads to low quality of life for patients and their families (8,9).…”

“…Related studies in low and middle income countries also found an association between delays and late diagnosis among cancer patients(16,17). Such late diagnosis results into poor prognosis and death(18).Related studies in Uganda and other developing countries have found other possible causes of patient and health system delays to include patients non-adherence to the recommended investigations, referral complexity as cancer investigations are done from different locations and lack of large scale population-based prostate cancer screening(5,10,19). Indeed, in our cohort all patients were assessed for prostate cancer after developing symptoms.…”