Early results of prostate cancer radiation therapy: an analysis with emphasis on research strategies to improve treatment delivery and outcomes

Abstract

BackgroundThere is scant data regarding disease presentation and treatment response among black men living in Africa. In this study we evaluate disease presentation and early clinical outcomes among Ghanaian men with prostate cancer treated with external beam radiotherapy (EBRT).MethodsA total of 379 men with prostate cancer were referred to the National Center for Radiotherapy, Ghana from 2003 to 2009. Data were collected regarding patient-and tumor-related factors such as age, prostate specific antigen (PSA), Gleason score (GS), clinical stage (T), and use of androgen deprivation therapy (ADT). For patients who received EBRT, freedom from biochemical failure (FFbF) was evaluated using the Kaplan-Meier method.ResultsOf 379 patients referred for treatment 69.6% had initial PSA (iPSA) > 20 ng/ml, and median iPSA was 39.0 ng/ml. A total of 128 men, representing 33.8% of the overall cohort, were diagnosed with metastatic disease at time of referral. Among patients with at least 2 years of follow-up after EBRT treatment (n=52; median follow-up time: 38.9 months), 3- and 5-year actuarial FFbF was 73.8% and 65.1% respectively. There was significant association between higher iPSA and GS (8–10 vs. ≤7, p < 0.001), and T stage (T3/4 vs. T1/2, p < 0.001).ConclusionsThis is the largest series reporting on outcomes after prostate cancer treatment in West Africa. That one-third of patients presented with metastatic disease suggests potential need for earlier detection to permit curative-intent therapy. Data from this study will aid in the strategic development of prostate cancer research roadmap in Ghana.

Prostate Cancer in Sub Saharan Africa

“…At diagnosis patients generally have a high PSA and for this reason qualify mostly for an intermediate or high risk disease status. At the exception of the Ghanaian study by Yamoah et al [36] more than half of the patients have a locally advanced disease with high proportion of metastasis.…”

“…Many efforts are being done to promote Radiation therapy in Ghana. A recent study by Yamoah et al [36] reports radiation therapy in a cohort of patients with organconfined disease including external beam radiation treatment (EBRT) in 141 patients, Brachytherapy in 13 patients and EBRT + Brachytherapy in 6 patients. Overall The 3 and 5 year actuarial freedom form biochemical failure was 73.8% and 65.1% respectively.…”

Prostate Cancer Disease Characteristics at the Time of Diagnosis and Initial Treatment Offered in a Tertiary Hospital at Ouagadougou (Burkina Faso)

“…Powell [17] evidenced that African Americans have similar pathogenic mechanisms and age at PCa initiation to Caucasians but they have a faster growth rate and/or an earlier transformation to clinically significant PCa. Late presentation of PCa is commonly reported from SSA [5,[18][19][20]. The reason for the late presentation in our environment may be explained by poor awareness of PCa, poverty, inadequate diagnostic facilities and the lack of access to healthcare [2,10,11,19].…”

Prostate cancer in men of African origin

“…Access to radiation therapy is limited in many nations 9,102 ; accordingly, the vast majority of literature on racial disparities with this therapy originates in the USA. African-American men are more likely to choose radiation therapy than surgical management than white men.…”