Presentation, patterns of care, and outcomes of patients with prostate cancer in sub‐Saharan Africa: A population‐based registry study

Abstract

BACKGROUND: Although prostate cancer (PCa) is the most commonly diagnosed cancer in men of sub-Saharan Africa (SSA), little is known about its management and survival. The objective of the current study was to describe the presentation, patterns of diagnosis, treatment, and survival of patients with PCa in 10 countries of SSA. METHODS: In this observational registry study with data collection from 2010 to 2018, the authors drew a random sample of 738 patients with PCa who were registered in 11 population-based cancer registries. They described proportions of patients receiving recommended care and presented survival estimates. Multivariable Cox regression was used to calculate hazard ratios comparing the survival of patients with and without cancer-directed therapies (CDTs). RESULTS:The study included 693 patients, and tumor characteristics and treatment information were available for 365 patients, 37.3% of whom had metastatic disease. Only 11.2% had a complete diagnostic workup for risk stratification. Among the nonmetastatic patients, 17.5% received curative-intent therapy, and 27.5% received no CDT. Among the metastatic patients, 59.6% received androgen deprivation therapy. The 3-and 5-year age-standardized relative survival for 491 patients with survival time information was 58.8% (95% confidence interval [CI], 48.5%-67.7%) and 56.9% (95% CI, 39.8%-70.9%), respectively. In a multivariable analysis, survival was considerably poorer among patients without CDT versus those with therapy. CONCLUSIONS: This study shows that a large proportion of patients with PCa in SSA are not staged or are insufficiently staged and undertreated, and this results in unfavorable survival. These findings reemphasize the need for improving diagnostic workup and access to care in SSA in order to mitigate the heavy burden of the disease in the region.

Current and projected number of years of life lost due to prostate cancer: A global study

“…Within the African continent, we observed substantial differences in the rates of YLL, which are likely to reflect the combined effects of genetics (discussed above), survival, and differential data quality (discuss below). With respect to survival, a recent study reported insufficient staging and undertreatment as major factors for high mortality among a large proportion of prostate cancer patients in sub‐Saharan Africa 24 …”

“…high mortality among a large proportion of prostate cancer patients in sub-Saharan Africa. 24 Undiagnosed prostate cancers may cause death without being detected, leading to a misclassification of the cause of death and an underestimate of the prostate cancer burden. Particularly, in lowand-middle-income countries access to cancer screening and treatment may be limited.…”

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

“…For example, less than one-fifth of the non-metastatic group received therapy with curative intent. 7 Meanwhile, the Caribbean, despite having its own set of harmonized NCCN guidelines, lacks a comprehensive assessment of presentation, patterns of care, guideline adherence, and health outcomes of men afflicted with prostate cancer.…”

Prostate cancer and the added burden of COVID‐19 in sub‐Saharan Africa: Rethinking regional priorities for responsive and data‐driven cancer control programs

“…As such, collaborative efforts are required by multiple stakeholders to develop quality improvement interventions that can strengthen the capacity for early prostate cancer diagnosis in SSA. Findings by Seraphin and colleagues 2 also underscore the need to integrate such early diagnosis efforts with population‐based cancer registries to address existing quality gaps in epidemiological and clinical data.…”

“…In the most riveting and compelling manner, Greenberg and Washington 1 recently offered an editorial on the burden of prostate cancer in sub‐Saharan Africa (SSA). Drawing largely on a recent population‐based registry study, 2 they re‐echoed the rather worrying state of prostate cancer care in SSA as evidenced by the prevailing trends of delayed diagnosis, late‐stage presentation, suboptimal access to effective treatment options, and particularly high disease morbidity and mortality in the region. The study by Seraphin and colleagues 2 has remarkably deepened our understanding of the state of access to prostate cancer diagnosis, optimal treatment, and survival outcomes in SSA.…”