Management of Advanced and Metastatic Prostate Cancer: A Need for a Sub-Saharan Guideline

Abstract

The estimated incidence rate of prostate cancer in Africa was 22.0/100,000 in 2016. The International Agency for Research on Cancer (IARC) has cited prostate cancer as a growing health threat in Africa with approximated 28,006 deaths in 2010 and estimated 57,048 deaths in 2030. The exact incidence of advanced and metastatic prostate cancer is not known in sub-Saharan Africa. Hospital-based reports from the region have shown a rising trend with most patients presenting with advanced or metastatic disease. The management of advanced and metastatic prostate cancer is challenging. The available international guidelines may not be cost-effective for an African population. The most efficient approach in the region has been surgical castration by bilateral orchidectomy or pulpectomy. Medical androgen deprivation therapy is expensive and may not be available. Patients with metastatic castrate-resistant prostate cancer tend to be palliated due to the absence or cost of chemotherapy or second-line androgen deprivation therapy in most of Africa. A cost-effective guideline for developing nations to address the rising burden of advanced prostate cancer is warranted at this moment.

<p>Review of Testicular Tumor: Diagnostic Approach and Management Outcome in Africa</p>

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Incidence of prostate cancer in Eritrea: Data from the National Health Laboratory, Orotta Referral Hospital and Sembel Hospital 2011-2018

“…Like most countries in Africa [6], very few prostatectomy specimens are referred for histological examination in Eritrea. Many patients also present with advanced or metastatic disease [5,25]. To be sure, a majority of the patients in this study were diagnosed with advanced disease on the basis of clinical case ascertainment or case histories.…”

Metastatic Profile of Newly Diagnosed Prostate Cancer Patients in Calabar, South- South Nigeria

“…Prostate cancer incidence and mortality rates are known to vary widely by geographical location and ethnicity, with rates believed to be influenced by genetics, culture, diet and other environmental factors [1,2]. Men of African descent are more likely than white men to be diagnosed with aggressive prostate cancer (CaP) and in Africa, significantly higher proportion of men present late with advanced disease compared to most other regions of the world [3,2,4]. Reports from different parts of Nigeria indicate that prostate cancer is common and many patients present late with advanced and complicated disease [5][6][7].…”