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Iheanacho CO, Odili VU, Enakirerhi GE, Isiwele EM, Essiet A. Pattern, Clinical Characteristics, and Impact of Family History on Prostate-Specific Antigen in Prostate Cancer: A Multicenter Study. Am J Mens Health 2024; 18:15579883241264949. [PMID: 39054776 PMCID: PMC11282506 DOI: 10.1177/15579883241264949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 07/27/2024] Open
Abstract
Prostate cancer (PCa) is a major cause of illness and death in men of Sub-Sahara African origin. The study assessed the pattern of PCa, the effect of family history on PSA at diagnosis, and clinical characteristics of PCa in Nigeria. A cross-sectional survey of 200 participants was performed within a 12-month period in Nigeria. Data were collected through patients' interview and hospital records and analyzed using SPSS version 25. Descriptive and inferential statistics were performed. P values <.05 were significant. Mean age of 68.5 years was observed among the 200 study participants. Only 64 (32.0%) had a positive immediate family history of PCa, and 61 (30.5%) were not aware of their family cancer history. Most patients 140 (70.0%) had lower urinary tract symptom (LUTS)/lower back pain/leg pain, and the average Gleason score was 7.55 (±0.876). Symptoms of LUTS/lower back pain mostly occurred in patients between 58 and 79 years, while LUTS/leg pain was more common in persons between 60 and 84. Average PSA differed among participants; persons with no family cancer history (M = 143.989; 95% confidence interval [CI] = 114.849-173.129), family history of PCa (M = 165.463; 95% CI = 131.435), family history of cervical cancer (M = 133.456; 95% CI = 49.335-217.576), and persons with no knowledge of their family cancer history (M = 121.546; 95% CI = 89.234-153.857). Univariate one-way (F-Tests) showed that family history of cancer had no significant impact on patients' PSA (R2 = 0.017; adjusted R2 = 0.002; df = 3; F = 1.154; p = .329) at diagnosis. PCa mostly occurred in men within 60 to 70 years of age, and family history of cancer did not predict PSA at diagnosis. Patients presented to health facilities at advanced or metastatic stages. These findings highlight the need for policies and strategies that encourage early PCa screening.
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Affiliation(s)
- Chinonyerem O. Iheanacho
- Department of Clinical Pharmacy and Public Health, Faculty of Pharmacy, University of Calabar, Calabar, Nigeria
| | - Valentine U. Odili
- Department of Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Benin, Benin City, Nigeria
| | - Glen E. Enakirerhi
- Department of Urology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Edoise M. Isiwele
- Department of Urology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Akanimo Essiet
- Department of Urology, University of Calabar Teaching Hospital, Calabar, Nigeria
- Urology Department, Faculty of Clinical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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2
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Hansen RS, Biørn SH, Birk-Korch JB, Sheikh SP, Poulsen MH, Vinholt PJ. Prevalence of prostate cancer in men with haematuria: a systematic review and meta-analysis. BJU Int 2022; 131:530-539. [PMID: 36522728 DOI: 10.1111/bju.15950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To investigate the prevalence of prostate cancer in men attending evaluation for haematuria, as this could help healthcare providers to determine whether men with haematuria should have prostate examinations performed. METHODS The study was performed according to a pre-specified protocol uploaded to the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022299383). A systematic search of MEDLINE, Ovid and Google Scholar was performed in December 2021. Two independent researchers evaluated all titles, available abstracts, and full texts. We included studies on adult men (aged ≥18 years) describing haematuria and prostate cancer. RESULTS We screened 4252 titles and abstracts when available and assessed 350 studies in full text. In total, 65 studies were included and 42 was summarised in a meta-analysis. In total, 18 752 men with haematuria were included, and the pooled prevalence (95% confidence interval [CI]) of prostate cancer was 3.0% (2.0-4.1%). In men with macroscopic haematuria, the pooled prevalence (95% CI) of prostate cancer was 5.9% (2.9-9.9%; n = 265/5373). In men with microscopic haematuria, the pooled prevalence (95% CI) of prostate cancer was 1.4% (0.8-2.2%; n = 71/6642). CONCLUSION Our findings indicate that the prevalence of prostate cancer is considerable in men attending evaluation for haematuria. Therefore, digital rectal examination and prostate-specific antigen measurement should become a standard procedure for all men with haematuria, especially for men with macroscopic haematuria.
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Affiliation(s)
- Rasmus Søgaard Hansen
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
| | - Signe Hedengran Biørn
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
| | | | - Søren Paludan Sheikh
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
| | - Mads Hvid Poulsen
- Department of Urology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
| | - Pernille Just Vinholt
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
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Ahmed RO, Sewram V, Oyesegun AR, Ayele B, van Wyk A, Fernandez P. A comparison of clinicopathologic features of prostate cancer between Nigerian and South African black men. AFRICAN JOURNAL OF UROLOGY 2022; 28:6. [PMID: 35280496 PMCID: PMC8897758 DOI: 10.1186/s12301-022-00273-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/13/2022] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Globally, prostate cancer (PCa) is the commonest non-cutaneous male malignancy. It is more aggressive among black men with little known reasons as to the cause and continued trend among black men. This disproportionate pattern of PCa especially among black men of African ancestry resident in Africa calls for a closer look. Nigeria and South Africa, combined, have the highest cumulative risk incidence of PCa in Africa. The present study investigated the clinicopathologic behaviour of PCa among Nigerian and South African black men and the relationship between the disease and socio-demographic characteristics alongside medical co-morbidities.
Methods
A retrospective cross-sectional study was undertaken in which de-identified records of 234 black men with pathologically confirmed PCa between 2007 and 2017 from two tertiary hospitals, in Nigeria (National Hospital, Abuja) and South Africa (Tygerberg Hospital, Cape Town), were reviewed.
Results
Median age at presentation from both countries was 66 years (interquartile range, IQR 61–73 years) while the median PSA at presentation was 46 ng/ml (IQR 16–336.5 ng/ml). Half of the men (117/234) presented with locally advanced disease while metastatic disease was observed in 65.9% (27/41) of Nigerian men and 34.1% (14/41) of South African men. Thirty-three per cent of the men presented with organ-confined disease. Overall, Nigerian men presented with less organ-confined disease and significantly higher stage of disease (p < 0.001). Risk stratification using PSA, Gleason scores and T-staging showed that 84.2% (n = 197) of all the men presented with high-risk PCa disease. There was a statistically significant difference between Nigerian and South African black men (p = 0.003) in terms of disease risk at presentation. Logistic regression analysis showed that age (Adjusted OR 1.053 (95% CI 1.003–1.106), p = 0.003) and country of residence (Adjusted OR 4.281 (95% CI 1.690–10.844), p = 0.002) had a statistically significant relationship with high risk of PCa while disease co-morbidities (like diabetes and hypertension) and rural/urban location in both countries did not.
Conclusions
Disparities exist between PCa presentation and clinicopathologic behaviour among Nigerian and South African black men. Nigerian men showed higher disease risk at presentation. Environmental-genetic interactions need further exploration in the aetio-pathogenesis of PCa in black men of African ancestry.
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Odo C, Afogu EN, Odoemene CA, Obi AO, Mbaeri TU, Obiesie EA, Okeke CJ, Nnadozie UU, Ulebe AO. Prophylactic role of ciprofloxacin and ceftriaxone in prostate biopsy-related infection: randomized comparative study of bacterial spectrum and antibiotic sensitivities. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00258-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The mainstay for the diagnosis of prostate cancer is transrectal ultrasound-guided prostate biopsy. However, prostate biopsy is associated with a significant risk of complications including urinary tract infection. This study aims to compare the bacterial profile and antibiotic susceptibility pattern in urinary tract infection after prostate biopsy between patients on 2 different antimicrobial prophylactic regimens.
Methods
This was a comparative cross-sectional study done at the urology unit of our institution, over 13 months. Fifty-six patients who met the inclusion criteria made up the study population and were randomly assigned to two groups. Those in group 1 (28) received intravenous ciprofloxacin (Juhel) 400 mg at induction of anesthesia, while those in group 2 (28) received intravenous ceftriaxone (Rocephin) 1 g at induction of anesthesia. All patients received bisacodyl (dulcolax) rectal suppositories 20 mg nocte starting 2 nights before the procedure as well as intravenous metronidazole (Juhel) at induction of anesthesia. Urine samples were taken for urine culture and sensitivity three days after biopsy. Isolated organisms and their antibiotics sensitivities were documented. Statistical analysis was done using SPSS version 21.0 with the level of significance set at P < 0.05.
Results
In group 1 the prevalence of urinary tract infection was 61%. Escherichia coli was isolated in 11(64.71%) cases, Klebsiella species in 3(17.65%), staphylococcus aureus in 1(5.88%), Proteus species in 1(5.88%), and non-hemolytic streptococcus species in 1(5.88%). In this group, all isolated bacterial organisms were resistant to ciprofloxacin. In group 2 the prevalence of urinary tract infection was 43%. Klebsiella spp was isolated in 6(50%) cases, Pseudomonas aeruginosa in 3(25%), E. coli in 2(16.67%), Staphylococcus in 1(8.33%). In group 2 all isolated bacterial organisms were resistant to ceftriaxone.
Conclusion
Ciprofloxacin and ceftriaxone are both associated with a high rate of urinary tract infection when used as prophylaxis for prostate biopsy. The bacterial etiology of prostate biopsy-related urinary tract infection is dependent on the prophylactic antibiotics used. Based on the high rate of urinary tract infection associated with the use of either ciprofloxacin or ceftriaxone, we recommend a combination of both drugs as prophylaxis for prostate biopsy.
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Maluf FC, Gillessen S. Consensus on the Screening, Staging, Treatment, and Surveillance of Localized, Recurrent, and Metastatic Prostate Cancer: The First Global Prostate Cancer Consensus Conference for Developing Countries. JCO Glob Oncol 2021; 7:512-515. [PMID: 33856893 PMCID: PMC8162967 DOI: 10.1200/go.20.00518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Fernando Cotait Maluf
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Beneficência Portuguesa de São Paulo, Brazil.,Latin American Oncology Group (LACOG), Porto Alegre - RS, Brazil
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona and Università della Svizzera italiana, Lugano, Switzerland.,Manchester Cancer Research Centre, Division of Cancer Sciences, University of Manchester, United Kingdom
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6
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Irekpita E, Achor GO, Alili U. Assessment of the value of the different variants of abnormal digital rectal examination finding in predicting carcinoma of the prostate: a preliminary report of a two-center study. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-019-0013-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Digital rectal examination is a veritable tool for the clinical diagnosis and screening for carcinoma of the prostate. This study aims to assess the value of the different variables which constitute abnormal digital rectal examination (DRE) findings.
Results
Following ethical approval, one hundred and thirty-one men met the inclusion criteria and were enrolled in the study. The peak incidence of abnormal DRE finding was in the 8th decade of life, while the PPV was 66.5%. Of the total, 44 (33.5%) were nodular hyperplasia, 12 (9.2%) were prostate intra-epithelia neoplasia, while 75 (57.3%) were adenocarcinoma. With a positive predictive value (PPV) of 73.3%, a hard nodular feel was the only abnormal DRE finding that independently and significantly predicted the risk of prostatic adenocarcinoma. A suspicious nodule and obliterated median groove had PPV of 23.1% and lobar asymmetry, 0%. There was a statistically significant correlation (P = 0.005) between DRE findings and histology, between PSA and histology (P = 0.000) and between the size of the prostate and PSA value (P = 0.021). The mean size of the prostate was 101.2 g, standard deviation 92.11783, maximum 648 g and minimum 13.6 g.
Conclusion
Most of the variants of abnormal DRE findings do not sufficiently predict the risk of adenocarcinoma on their own. They need to be in combination with other DRE findings or a raised PSA to significantly predict adenocarcinoma.
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7
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Ojewuyi OO, Ikuerowo SO, Jeje EA, Adewole OA, Abolarinwa AA, Omisanjo OA. Bone mineral density in Nigerian men on androgen deprivation therapy for advanced prostate cancer. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00036-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cancer of the prostate (CaP) is the most frequently diagnosed non-cutaneous malignancy worldwide, and it is the second leading cause of death from cancer in men. In the developing world, majority of patients with CaP present in advanced stage and often times, androgen deprivation therapy (ADT) is the only treatment option available. ADT has been reported to increase the risk of osteopenia and osteoporosis in patients with CaP in studies done predominantly among the Caucasians. There is a dearth of report of the effect of ADT on CaP in the black population most especially Nigerian population despite our high incidence of CaP. The aim of this study was to determine the effect of advanced CaP and its treatment using ADT on bone mineral density (BMD) in our patients.
Results
The age of the patients ranged from 54 to 88 years (mean 70.15 ± 6.7) and 50 to 85 years (mean 68.92 ± 8.5) for the case and control groups, respectively. The mean BMD of the control group (0.26 ± 1.5) was significantly higher than the case group pre-ADT (− 0.78 ± 1.7) (p = 0.044). Post-ADT, the BMD was significantly lower (− 1.15 ± 1.7) than pre-ADT (p = 0.001) among the case group.
Conclusion
Advanced CaP was found to be associated with a decrease in BMD, and ADT was associated with a further decline in the BMD. Therefore, prevention and treatment of skeletal-related events is vital in management of patients with advanced CaP.
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8
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Enemugwem RA, Eze BA, Ejike U, Asuquo EO, Tobin A. Prostate cancer screening: assessment of knowledge and willingness to screen among men in Obio Akpor LGA, Rivers State, Nigeria. AFRICAN JOURNAL OF UROLOGY 2019. [DOI: 10.1186/s12301-019-0010-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Worldwide prostate cancer is the second most frequent cause of cancer deaths and is the commonest cancer diagnosed among Nigerian men. Screening techniques can be employed to detect the disease earlier in apparently healthy individuals, and increasing evidence shows that this can decrease morbidity and mortality of the disease. The objective of this study was to assess the knowledge and intention to screen for prostate cancer among men in Obio Akpor Local Government Area, Rivers State, Nigeria.
Results
Respondents were within the ages of 40 and 75 years. The most frequently reported source of information about prostate cancer screening was the news media 72 (35.0%) and healthcare workers 62 (30.1%). Thirty (14.9%) of the respondents had good knowledge of prostate cancer, while 80 (39.6%) had good knowledge of prostate cancer screening methods. Concerning prostate cancer screening methods, only 47 (23.3%) were able to correctly identify screening methods for prostate cancer. With regards to intention to screen, 104 (51.5%) were willing to be screened for prostate cancer.
Conclusion
This study showed that the knowledge of prostate cancer was poor with only approximately half of the participants expressing intentions to screen for the disease. This emphasizes the need for the Rivers State Ministry of Health to carry out awareness campaigns on the importance of prostate screening.
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9
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Taitt HE. Global Trends and Prostate Cancer: A Review of Incidence, Detection, and Mortality as Influenced by Race, Ethnicity, and Geographic Location. Am J Mens Health 2018; 12:1807-1823. [PMID: 30203706 PMCID: PMC6199451 DOI: 10.1177/1557988318798279] [Citation(s) in RCA: 246] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Although research has reported that prostate cancer (PCa) incidence and mortality rates are among the highest for African Americans, the data is inconclusive regarding PCa rates in native African men, Black men residing in other countries, and men in Asia, Europe, and the Americas. Data reveals that prostate-specific antigen (PSA) testing and disease incidence have risen significantly in developing and Asian countries, and PCa has become one of the leading male cancers in many of those nations. The objective of this study was to review published peer-reviewed studies that address PCa in different regions of the world to get a better understanding of how PCa incidence, prevalence, detection, and mortality are influenced by race, ethnicity, and geography. A secondary goal was to compare PCa data from various world regions to contextualize how disproportionate the incidence and mortality rates are among men from the African diaspora versus men of European, Hispanic, and Asian descent, as well as to highlight the need for more robust screening and treatment guidelines in developing countries. There are differences in incidence and mortality rates between men of African, Asian, Hispanic, and European ancestry, confirming the involvement of genetic factors. However, differences between men of the same race and ethnicity who live in different countries suggest that environmental factors may also be implicated. Availability and access to diagnostic and health-care services as well as recommendations regarding PCa testing vary from country to country and contribute to the variability in incidence and mortality rates.
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Affiliation(s)
- Harold Evelyn Taitt
- College of Health Sciences, Walden University, Minneapolis, MN, USA
- Harold Evelyn Taitt, 16870 91st Ave N, Maple Grove, MN 55311, USA.
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10
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Anderson B, Marshall-Lucette S. Prostate cancer among Jamaican men: exploring the evidence for higher risk. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2016; 25:1046-1051. [PMID: 27792445 DOI: 10.12968/bjon.2016.25.19.1046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Historically, black men of African descent have been disproportionately affected by prostate cancer compared with Caucasian men. African-Caribbean men are generally at higher risk of prostate cancer, with Jamaican men noted to have the highest incidence in the world. No robust evidence exists for the increased incidence among Jamaican men, or indeed, a clear explanation for the reasons these men are at a greater risk of developing the disease in comparison with other African-Caribbean men. METHODS AND FINDINGS A literature review was undertaken. The findings indicated that black men of African descent, specifically Jamaican men, are at greater risk of prostate cancer and this finding applies to Africa, the Caribbean, the UK and USA. CONCLUSIONS Current evidence for the higher incidence of prostate cancer among Jamaican men remains inconclusive and does not provide a clear explanation for its prevalence. More comparative studies are required to identify any predisposing factors responsible for this anomaly, worldwide. The involvement of health professionals in these research undertakings is important to obtaining insight into prostate cancer and in devising strategies to improve management and health outcomes.
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Affiliation(s)
- Beverley Anderson
- Macmillan Uro-Oncology Clinical Nurse Specialist, Epsom and St Helier NHS Trust
| | - Sylvie Marshall-Lucette
- Senior Lecturer, Faculty of Health, Social Care and Education, St George's, University of London
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11
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Udeh EI, Nnabugwu II, Ozoemena FO, Ugwumba FO, Aderibigbe ASO, Ohayi SR, Echetabu KN. Prostate-specific antigen density values among patients with symptomatic prostatic enlargement in Nigeria. World J Surg Oncol 2016; 14:174. [PMID: 27356753 PMCID: PMC4928335 DOI: 10.1186/s12957-016-0921-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 06/14/2016] [Indexed: 11/25/2022] Open
Abstract
Background This study aims to estimate the prostate-specific antigen density (PSAD) cutoff level for detecting prostate cancer (CAP) in Nigerian men with “grey zone PSA” (4–10 ng/ml) and normal digital rectal examination findings. We addressed this research question: Is the international PSAD cutoff of 0.15 ideal for detecting CAP in our symptomatic patients with “grey zone PSA?” Methods Aim: To estimate the prostate-specific antigen density (PSAD) cutoff level for detecting CAP in Nigerian men with “grey zone PSA” (4–10 ng/ml) and normal digital rectal examination findings. Design: Prospective. Setting: A tertiary medical center in Enugu, Nigeria. Participants: Two hundred and fifty-four men with either benign prostatic hyperplasia (BPH) or CAP were recruited. Intervention: Patients with PSA above 4 ng/ml or abnormal digital rectal examination or hypoechoic lesion in the prostate were biopsied. Outcome measures: PSAD and histology report of BPH or CAP. Results Ninety-seven patients had CAP while 157 had benign prostatic hyperplasia (BPH). Seventy-two patients had their serum PSA value within the range of 4.0 and 10 ng/ml. PSAD cutoff level to detect CAP was 0.04 (sensitivity 95.88 %; specificity 28.7 %). Conclusions The PSAD cutoff level generated for Nigerian men in this study is 0.04 which is relatively different from international consensus. This PSAD cutoff level has a positive correlation with histology and could detect patients with CAP who have “grey zone PSA.”
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Affiliation(s)
- Emeka I Udeh
- Department of Surgery, University of Nigeria, Enugu, Nigeria. .,Department of Surgery, Faculty of medicine, College of medicine, University of Nigeria, Enugu, Nigeria.
| | | | | | - Fred O Ugwumba
- Department of Surgery, University of Nigeria, Enugu, Nigeria
| | | | - Samuel R Ohayi
- Department of Radiology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Kevin N Echetabu
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Adeloye D, David RA, Aderemi AV, Iseolorunkanmi A, Oyedokun A, Iweala EEJ, Omoregbe N, Ayo CK. An Estimate of the Incidence of Prostate Cancer in Africa: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0153496. [PMID: 27073921 PMCID: PMC4830589 DOI: 10.1371/journal.pone.0153496] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 03/27/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Prostate cancer (PCa) is rated the second most common cancer and sixth leading cause of cancer deaths among men globally. Reports show that African men suffer disproportionately from PCa compared to men from other parts of the world. It is still quite difficult to accurately describe the burden of PCa in Africa due to poor cancer registration systems. We systematically reviewed the literature on prostate cancer in Africa and provided a continent-wide incidence rate of PCa based on available data in the region. METHODS A systematic literature search of Medline, EMBASE and Global Health from January 1980 to June 2015 was conducted, with additional search of Google Scholar, International Association of Cancer Registries (IACR), International Agency for Research on Cancer (IARC), and WHO African region websites, for studies that estimated incidence rate of PCa in any African location. Having assessed quality and consistency across selected studies, we extracted incidence rates of PCa and conducted a random effects meta-analysis. RESULTS Our search returned 9766 records, with 40 studies spreading across 16 African countries meeting our selection criteria. We estimated a pooled PCa incidence rate of 22.0 (95% CI: 19.93-23.97) per 100,000 population, and also reported a median incidence rate of 19.5 per 100,000 population. We observed an increasing trend in PCa incidence with advancing age, and over the main years covered. CONCLUSION Effective cancer registration and extensive research are vital to appropriately quantifying PCa burden in Africa. We hope our findings may further assist at identifying relevant gaps, and contribute to improving knowledge, research, and interventions targeted at prostate cancer in Africa.
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Affiliation(s)
- Davies Adeloye
- Demography and Social Statistics, and the e-Health Research Cluster, Covenant University, PMB 1023, Ota, Ogun State, Nigeria
- Centre for Global Health Research and the World Health Organization Collaborating Centre for Population Health Research and Training, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Rotimi Adedeji David
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Adewale Victor Aderemi
- Department of Biochemistry, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | | | | | - Emeka E. J. Iweala
- Department of Biological Sciences, Covenant University, PMB 1023, Ota, Ogun State, Nigeria
| | - Nicholas Omoregbe
- Department of Computer and Information Sciences, and the eHealth Research Cluster, Covenant University, PMB 1023, Ota, Ogun State, Nigeria
| | - Charles K. Ayo
- Department of Computer and Information Sciences, and the eHealth Research Cluster, Covenant University, PMB 1023, Ota, Ogun State, Nigeria
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Agalliu I, Adebiyi AO, Lounsbury DW, Popoola O, Jinadu K, Amodu O, Paul S, Adedimeji A, Asuzu C, Asuzu M, Ogunbiyi OJ, Rohan T, Shittu OB. The feasibility of epidemiological research on prostate cancer in African men in Ibadan, Nigeria. BMC Public Health 2015; 15:425. [PMID: 25927535 PMCID: PMC4419477 DOI: 10.1186/s12889-015-1754-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 04/17/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Men of African descent have the highest incidence and mortality rates of prostate cancer (PrCa) worldwide. Notably, PrCa is increasing in Africa with Nigerian men being mostly affected. Thus, it is important to understand risk factors for PrCa in Nigeria and build capacity for cancer research. The goals of this study were to determine the feasibility of conducting an epidemiological study of PrCa and to obtain preliminary data on risk factors for PrCa in Nigeria. METHODS A case-control study (50 cases/50 controls) was conducted at the University College Hospital (UCH) in Ibadan, Nigeria, between October 2011 and December 2012. Men aged 40 to 80 years were approached for the study and asked to provide informed consent and complete the research protocol. Logistic regression models were used to examine associations between demographic, social and lifestyle characteristics and risk of PrCa. RESULTS The participation rate among cases and controls was 98% and 93%, respectively. All participants completed a questionnaire and 99% (50 cases/49 controls) provided blood samples. Cases had a median serum diagnostic PSA of 73 ng/ml, and 38% had a Gleason score 8-10 tumor. Family history of PrCa was associated with a 4.9-fold increased risk of PrCa (95% CI 1.0 - 24.8). There were statistically significant inverse associations between PrCa and height, weight and waist circumference, but there was no association with body mass index (kg/m(2)). There were no associations between other socio-demographic and lifestyle characteristics and PrCa risk. CONCLUSION This feasibility study demonstrated the ability to ascertain and recruit participants at UCH and collect epidemiological, clinical and biospecimen data. Our results highlighted the advanced clinical characteristics of PrCa in Nigerian men, and that family history of PrCa and some anthropometric factors were associated with PrCa risk in this population. However, larger studies are needed to better understand the epidemiological risk factors of PrCa in Nigeria.
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Affiliation(s)
- Ilir Agalliu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Building, Room 1315-B, Bronx, NY, 10461, USA.
- Department of Urology, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Akin O Adebiyi
- Department of Community Medicine, Clinical Epidemiology Unit, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - David W Lounsbury
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Building, Room 1315-B, Bronx, NY, 10461, USA.
| | - Oluwafemi Popoola
- Department of Community Medicine, Clinical Epidemiology Unit, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Kola Jinadu
- Department of Community Medicine, Clinical Epidemiology Unit, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Olukemi Amodu
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Suvam Paul
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Building, Room 1315-B, Bronx, NY, 10461, USA.
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Building, Room 1315-B, Bronx, NY, 10461, USA.
| | - Chioma Asuzu
- Department of Radiotherapy, Psycho-Oncology Unit, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Michael Asuzu
- Department of Community Medicine, Clinical Epidemiology Unit, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Olufemi J Ogunbiyi
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Thomas Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Building, Room 1315-B, Bronx, NY, 10461, USA.
| | - Olayiwola B Shittu
- Department of Surgery, Urology Unit, College of Medicine, University of Ibadan, Ibadan, Nigeria.
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A ten-year study of prostate cancer specimens at Ahmadu Bello University Teaching Hospital (A.B.U.T.H), Zaria, Nigeria. AFRICAN JOURNAL OF UROLOGY 2015. [DOI: 10.1016/j.afju.2014.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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Ndoye M, Niang L, Gandaho KI, Jalloh M, Labou I, Gueye S. [Advanced prostate cancer in Senegal. Clinical aspects at the General Hospital of Grand Yoff]. Prog Urol 2013; 24:271-5. [PMID: 24674331 DOI: 10.1016/j.purol.2013.08.317] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 03/12/2013] [Accepted: 08/08/2013] [Indexed: 11/25/2022]
Abstract
UNLABELLED Prostate cancer is a common disease, which continues to be discovered at advanced stages in Africa, despite improved diagnostic tools. AIM The authors report the experience of the Department of Urology, General Hospital of Grand Yoff Dakar in the diagnostic of advanced prostate cancer. MATERIAL This was a retrospective descriptive study on patients followed for advanced prostate cancer during the period from January 1st, 2004 to May 31st, 2010. RESULTS There were 102 people aged from 51 to 96 years with an average of 71 ± 9 years. A comorbid condition was associated in 24.5 % of cases. The circumstances of discovery were pain (32 cases), neurological signs (17 cases), and urinary disorders. DRE had objectified an abnormality in all patients. The serum levels of prostate specific antigen ranged from 5.88 ng/mL to 21,660 ng/mL, with an average of 1447.57 ± 812 ng/mL. A prostate biopsy was performed in 44 patients and prostatic adenocarcinoma was found in 97.7 % of cases with Gleason scores greater than 7 (33 cases). We found different metastatic sites at vertebral column (23 cases), at lung (14 cases), and on pelvic bones (11 cases). CONCLUSION The prostate cancer is a serious condition with high morbidity and mortality. The diagnosis is not made early in developing countries. We need a strategic plan to improve the early screening and we should develop supportive care too because of the high number of advanced cases diagnosed in our context.
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Affiliation(s)
- M Ndoye
- Hôpital général de Grand Yoff, Dakar, Sénégal.
| | - L Niang
- Hôpital général de Grand Yoff, Dakar, Sénégal
| | - K I Gandaho
- Hôpital général de Grand Yoff, Dakar, Sénégal.
| | - M Jalloh
- Hôpital général de Grand Yoff, Dakar, Sénégal
| | - I Labou
- Hôpital général de Grand Yoff, Dakar, Sénégal
| | - S Gueye
- Hôpital général de Grand Yoff, Dakar, Sénégal
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16
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Outcomes after Radical Prostatectomy in Ghanaians: A Surgeon's Early Experience. ISRN UROLOGY 2013; 2013:832496. [PMID: 23710370 PMCID: PMC3655646 DOI: 10.1155/2013/832496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/09/2013] [Indexed: 11/29/2022]
Abstract
Background. There is a lack of expertise in the procedure of open radical retropubic prostatectomy in West Africa therefore necessitating the training of urologists in the subregion in this procedure. Aim. This report looks at the early outcomes of a single surgeon in this procedure after an SIU fellowship. Methodology. A prospective study of the initial twenty consecutive patients with clinically localized prostate cancer that underwent open radical retropubic prostatectomy at the Korle Bu Teaching hospital, Accra.
Results. The mean followup was 19.5 months (range 7 months–36 months). The mean age was 62.7 yrs. For the clinical stage, 60% were T1c and 40% T2a with a mean Gleason score of 6.5. The mean estimated blood loss was 1140.0 mLs with a transfusion rate of 70%. For the pathologic stage, pT2 cancers formed 60%, pT3 25%, and pT4 5% with a mean Gleason score of 6.8. No lymph node involvement was noted. The perioperative complications rate was 15%, a postoperative potency recovery rate of 78.6% with all the patients being continent of urine. The tPSA of 95% of the patients had remained less than 0.4 ng/mL. Conclusion. The SIU scholarship offers an avenue for training in radical prostatectomy for sub-Saharan Africa.
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Rebbeck TR, Devesa SS, Chang BL, Bunker CH, Cheng I, Cooney K, Eeles R, Fernandez P, Giri VN, Gueye SM, Haiman CA, Henderson BE, Heyns CF, Hu JJ, Ingles SA, Isaacs W, Jalloh M, John EM, Kibel AS, Kidd LR, Layne P, Leach RJ, Neslund-Dudas C, Okobia MN, Ostrander EA, Park JY, Patrick AL, Phelan CM, Ragin C, Roberts RA, Rybicki BA, Stanford JL, Strom S, Thompson IM, Witte J, Xu J, Yeboah E, Hsing AW, Zeigler-Johnson CM. Global patterns of prostate cancer incidence, aggressiveness, and mortality in men of african descent. Prostate Cancer 2013; 2013:560857. [PMID: 23476788 PMCID: PMC3583061 DOI: 10.1155/2013/560857] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 10/08/2012] [Indexed: 02/07/2023] Open
Abstract
Prostate cancer (CaP) is the leading cancer among men of African descent in the USA, Caribbean, and Sub-Saharan Africa (SSA). The estimated number of CaP deaths in SSA during 2008 was more than five times that among African Americans and is expected to double in Africa by 2030. We summarize publicly available CaP data and collected data from the men of African descent and Carcinoma of the Prostate (MADCaP) Consortium and the African Caribbean Cancer Consortium (AC3) to evaluate CaP incidence and mortality in men of African descent worldwide. CaP incidence and mortality are highest in men of African descent in the USA and the Caribbean. Tumor stage and grade were highest in SSA. We report a higher proportion of T1 stage prostate tumors in countries with greater percent gross domestic product spent on health care and physicians per 100,000 persons. We also observed that regions with a higher proportion of advanced tumors reported lower mortality rates. This finding suggests that CaP is underdiagnosed and/or underreported in SSA men. Nonetheless, CaP incidence and mortality represent a significant public health problem in men of African descent around the world.
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Affiliation(s)
- Timothy R. Rebbeck
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 217 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Susan S. Devesa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Bao-Li Chang
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 217 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA
| | - Clareann H. Bunker
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Tobago Health Studies Office, Scarborough, Tobago, Trinidad and Tobago
| | - Iona Cheng
- Cancer Prevention Institute of California, Fremont, CA 94538, USA
- Department of Health Research and Policy, Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA 94305, USA
| | - Kathleen Cooney
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Rosalind Eeles
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Pedro Fernandez
- Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa
| | - Veda N. Giri
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Serigne M. Gueye
- Hôpital Général de Grand Yoff, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Christopher A. Haiman
- Department of Preventive Medicine and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Brian E. Henderson
- Department of Preventive Medicine and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Chris F. Heyns
- Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa
| | - Jennifer J. Hu
- School of Medicine and Sylvester Cancer Center, University of Miami Miller, Miami, FL 33442, USA
| | - Sue Ann Ingles
- Department of Preventive Medicine and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - William Isaacs
- The Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD 21287, USA
| | - Mohamed Jalloh
- Hôpital Général de Grand Yoff, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Esther M. John
- Cancer Prevention Institute of California, Fremont, CA 94538, USA
- Department of Health Research and Policy, Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA 94305, USA
| | - Adam S. Kibel
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02138, USA
| | - LaCreis R. Kidd
- Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY 40292, USA
| | - Penelope Layne
- Guyana Cancer Registry, Ministry of Health, Queenstown, Guyana
| | - Robin J. Leach
- Department of Urology and the Cancer, Therapy and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | | | - Michael N. Okobia
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
- School of Medicine, University of Benin, Benin City, Nigeria
| | | | - Jong Y. Park
- Department of Cancer Epidemiology and Center for Equal Health, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Alan L. Patrick
- Tobago Health Studies Office, Scarborough, Tobago, Trinidad and Tobago
| | - Catherine M. Phelan
- Department of Cancer Epidemiology and Center for Equal Health, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Camille Ragin
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Robin A. Roberts
- School of Clinical Medicine and Research, University of the West Indies, Nassau, Bahamas
| | - Benjamin A. Rybicki
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI 48202, USA
| | | | - Sara Strom
- Department of Epidemiology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ian M. Thompson
- Department of Urology and the Cancer, Therapy and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - John Witte
- Departments of Epidemiology and Biostatistics and Urology, Institute for Human Genetics, University of California, San Francisco, CA 94122, USA
| | - Jianfeng Xu
- Wake Forest University, Winston-Salem, NC 27157, USA
| | - Edward Yeboah
- Korle Bu Teaching Hospital and University of Ghana Medical School, Accra, Ghana
| | - Ann W. Hsing
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Charnita M. Zeigler-Johnson
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 217 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
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Niang L, Ndoye M, Ouattara A, Jalloh M, Labou M, Thiam I, Kouka SC, Diaw JJ, Gueye SM. [Management of prostate cancer in Senegal: what is being done?]. Prog Urol 2013; 23:36-41. [PMID: 23287482 DOI: 10.1016/j.purol.2012.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 08/18/2012] [Accepted: 09/09/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the management of patients with prostate cancer in Senegal. MATERIALS AND METHODS We performed a retrospective descriptive study, based on the medical records of patients managed for prostate cancer during a period of six years and a half from January 1, 2004, to June 30, 2010. All records of inpatients and outpatients managed for prostate cancer were collected. Data collection was performed through a standardized survey form, and included the following parameters: age, presence or absence of known history of prostate cancer in siblings, circumstances of discovery, clinical and paraclinical examination, histology and therapeutic modalities. RESULTS We studied the records of 164 patients with prostate cancer. The mean age of our patients was 65years, ranging from 43 to 96years. The circumstances of diagnosis were mostly due to lower urinary tract symptoms. Digital rectal examination was suggestive in 87% of cases, and PSA levels were high in 100% of cases, ranging from 5.88ng/ml to 21,660ng/ml, with a mean of 1447.57ng/ml. Half of the patients had PSA levels greater than or equal to 100ng/ml. The most common histological type was adenocarcinoma. During the study period, 49 radical prostatectomies were performed. The mean PSA levels of patients who underwent a prostatectomy were 23.4ng/ml. Radical retropubic prostatectomy was performed in 35 patients, and radical perineal prostatectomy was performed in 10 cases. Pulpectomy was the method most commonly used in metastatic prostate cancer; it was performed in 48 patients. After resistance to castration, antiandrogens were reintroduced in 13 patients, and diethylstilbestrol in four patients. Only two patients underwent a taxane-based chemotherapy regimen. CONCLUSION The diagnosis of prostate cancer was usually tardive in Senegal. Treatment often involves surgical castration. Prostatectomy was only very seldom indicated.
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Affiliation(s)
- L Niang
- Service d'urologie-andrologie, hôpital Général-du-Grand-Yoff, BP 3270, Dakar, Sénégal.
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19
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Ezenwa EV, Tijani KH, Jeje EA, Soriyan OO, Ogunjimi MA, Ojewola RW, Ajie OI, El-Nahas AR. The value of percentage free prostate specific antigen (PSA) in the detection of prostate cancer among patients with intermediate levels of total PSA (4.0-10.0 ng/mL) in Nigeria. Arab J Urol 2012; 10:394-400. [PMID: 26558056 PMCID: PMC4442964 DOI: 10.1016/j.aju.2012.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives To assess the value of percentage free prostate-specific antigen (%fPSA) in the detection of prostate cancer among Nigerian men with an intermediate total PSA level (4–10 ng/mL), and to show if the optimum threshold for biopsy is different from Caucasian values when the widely used (six-core, digitally directed) prostate biopsy protocol in Nigerians is applied. Patients and methods The study included 105 patients aged >50 years, with a palpably benign prostate gland and intermediate levels of total PSA (4–10 ng/mL). These patients had a free PSA assay and a transrectal digitally directed six-core biopsy of the prostate. The %fPSA was calculated and the optimum threshold value for detecting prostate cancer was determined. Results The mean (SD) age of the patients was 64.4 (6.6) years and their mean (SD) total PSA level was 6.6 (1.7) ng/mL. Of these men 14 (13.3%) had cancer of the prostate detected by the prostate biopsy. The %fPSA level related directly to sensitivity values but inversely to the specificity and the positive predictive values. The best threshold of %fPSA for detecting cancer in these men was <40%, with a sensitivity of 100%, specificity of 93.4% and a positive predictive value of 70% (P < 0.05). Conclusions In evaluating Nigerian patients with a palpably benign prostate gland and within the intermediate total PSA range, when digitally directed biopsy protocol is adopted, a %fPSA threshold of <40% will detect significant percentage of those with prostate cancer, with a minimal number of unnecessary biopsies. This value differs from that reported in western studies in which transrectal ultrasonography-directed biopsy was used.
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Affiliation(s)
- E V Ezenwa
- Division of Urology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - K H Tijani
- Division of Urology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - E A Jeje
- Division of Urology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - O O Soriyan
- Department of Chemical Pathology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - M A Ogunjimi
- Division of Urology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - R W Ojewola
- Division of Urology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - O I Ajie
- Department of Chemical Pathology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - A R El-Nahas
- Urology Department, Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt
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Oranusi C, Mbieri U, Oranusi I, Nwofor A. Prostate cancer awareness and screening among male public servants in Anambra State, Nigeria. AFRICAN JOURNAL OF UROLOGY 2012. [DOI: 10.1016/j.afju.2012.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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Ikuerowo S, Omisanjo O, Bioku M, Ajala M, Esho J. Effect of Obesity on Serum Prostate-Specific Antigen in Nigerian Men. Urol Int 2012; 89:52-6. [DOI: 10.1159/000337171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 02/06/2012] [Indexed: 01/26/2023]
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22
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Prostate cancer screening, detection and treatment practices, among Sub-Saharan African urologists. AFRICAN JOURNAL OF UROLOGY 2011. [DOI: 10.1007/s12301-011-0016-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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23
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Ogunbiyi OJ. Impact of health system challenges on prostate cancer control: health care experiences in Nigeria. Infect Agent Cancer 2011; 6 Suppl 2:S5. [PMID: 21992224 PMCID: PMC3194184 DOI: 10.1186/1750-9378-6-s2-s5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Prostate cancer is the second most frequently diagnosed cancer of men (913 000 new cases, 13.8% of the total) and the fifth most common cancer overall. Prostate cancer is the sixth leading cause of death from cancer in men (6.1% of the total). The incidence of prostate cancer in Nigerian men is believed to be on the increase and it had become the number one cancer in 1999, constituting 11% of all male cancers in the population served by the Ibadan cancer Registry. Studies from Ibadan and from other sites in Nigeria (Benin, Calabar, Kano, Lagos, Maiduguri, and Zaria) have shown an increasing incidence of prostate cancer accounting for anything between 6 and 12 % of total cancers in these centres and up to about 18% of prostatic neoplasms in some. Most patients present in late stage disease, and the mortality is high. It is uncertain whether there is a biophysical component to the increased incidence of prostate cancer in Nigerian and other West African men although a few studies point in this direction. It appears there is inadequate information regarding the incidence and mortality of prostate cancer, and that health care professionals do not routinely provide information regarding the importance of screening for prostate cancer before age 50 for high-risk populations. The Revised National health Policy for Nigeria (Sept 2004) has as its long term goal ‘to provide the entire population with adequate access, not only to primary health care but also to secondary and tertiary services through a well functioning referral system’ and also “Ensuring equitable distribution of human resources for healthcare delivery between urban and rural areas, including difficult terrain, such as mountainous, riverine and inaccessible areas of the country.” At the moment however, Public expenditure on health is less than $8 per capita, compared to the $34 recommended internationally. Private expenditures are estimated to be over 70% of total health expenditure, most of this from out-of-pocket. Yet there is endemic poverty. The National Health Insurance scheme (NHIS) is presently severely limited in its allowances and certainly so for cancer care.
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Affiliation(s)
- Olufemi J Ogunbiyi
- Department of pathology, University College Hospital/ College of medicine, University of Ibadan, P,M,B, 5116, Ibadan, Oyo state, Nigeria.
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24
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Abstract
UNLABELLED Prostate cancer (CaP) disparities in the black man calls for concerted research efforts. This review explores the trend and focus of CaP research activities in Nigeria, one of the ancestral nations for black men. It seeks to locate the place of the Nigerian research environment in the global progress on CaP disparities. Literature was reviewed mainly through a Pubmed search with the terms "prostate cancer"and "Nigeria", as well as from internet and hard copies of journal pages. FINDINGS One of the earliest publications about CaP in Nigeria was in 1973 from the nation's 1st tertiary hospital in Ibadan, reporting low incidence, followed by a lull of nearly one decade. In 1980, the incidence rate of CaP was reported as almost similar for black men in Ibadan and Washington and from then on, research work from surgeons and pathologists, from the south to the north, east to west, continued to report increasing prevalence of CaP. Apart from epidemiology, other areas of research include KAP (knowledge attitude and practice) studies (poor education of caregivers and population), histopathology (mostly adenocarcinoma), diagnosis (digital rectal examination [DRE], prostate specific antigen [PSA], ultrasound), clinical features (late presentation and high mortality), and prevention (lifestyle, education and screening). As of today there is a gaping dearth of molecular and genetic studies. CONCLUSION The global focus on CaP disparities in black men calls for more efforts from Africa, in all areas of research, along with international collaborations for capacity building.
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Kheirandish P, Chinegwundoh F. Ethnic differences in prostate cancer. Br J Cancer 2011; 105:481-5. [PMID: 21829203 PMCID: PMC3170971 DOI: 10.1038/bjc.2011.273] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 06/24/2011] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It is recognised that the risk of prostate cancer is higher in black men than in white men worldwide. Recent studies suggest that a number of genetic mutations in black men predispose them to this disease; hence, race as well as environmental factors such as diet and migration are thought to be the determining factors. METHODS This review compares data from the United States (US), which suggest that African-American men have a 60% higher risk for developing prostate cancer with poorer prognosis in comparison with their white counterparts, with similar studies carried out in the United Kingdom (UK) and also in African and Caribbean countries. CONCLUSIONS Studies from the United States and the United Kingdom came to significantly different conclusions, and this has implications for policy development, awareness raising among black men in each country and clinical practice.
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Affiliation(s)
- P Kheirandish
- Department of Urology, St Bartholomew's hospital, Barts and The London NHS Trust, West Smithfield, London EC1A 7BE, UK.
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Gunderson K, Wang CY, Wang R. Global prostate cancer incidence and the migration, settlement, and admixture history of the Northern Europeans. Cancer Epidemiol 2011; 35:320-7. [PMID: 21167803 PMCID: PMC3309613 DOI: 10.1016/j.canep.2010.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 11/23/2010] [Accepted: 11/23/2010] [Indexed: 12/22/2022]
Abstract
The most salient feature of prostate cancer is its striking ethnic disparity. High incidences of the disease are documented in two ethnic groups: descendents of the Northern Europeans and African Americans. Other groups, including native Africans, are much less susceptible to the disease. Given that many risk factors may contribute to carcinogenesis, an etiological cause for the ethnic disparity remains to be defined. By analyzing the global prostate cancer incidence data, we found that distribution of prostate cancer incidence coincides with the migration and settlement history of Northern Europeans. The incidences in other ethnic groups correlate to the settlement history and extent of admixture of the Europeans. This study suggests that prostate cancer has been spread by the transmission of a genetic susceptibility that resides in the Northern European genome.
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Affiliation(s)
- Kristin Gunderson
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322
| | - Christopher Y. Wang
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322
| | - Ruoxiang Wang
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048
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27
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Ahmed M. Prostate cancer diagnosis in a resource-poor setting: the changing role of digital rectal examination. Trop Doct 2011; 41:141-3. [DOI: 10.1258/td.2011.110061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We undertook this study in order to determine the current role of digital rectal examination (DRE) in the diagnosis of prostate cancer in a resource-poor setting. The diagnosis of prostate cancer has been revolutionized by the introduction of prostate-specific antigen (PSA), transrectal ultrasound (TRUS) for biopsy guidance and more efficient biopsy equipment, but they are not readily available in most developing countries. This is a prospective study of 131 patients with suspected prostate cancer based on clinical presentation, DRE and elevated PSA. The presence or absence of cancer was confirmed by biopsy and histologic examination. Patients with screen- or incidentally-detected prostate cancer were excluded. The most common symptom was the development of lower urinary tract symptoms (LUTS). All patients had abnormal DRE and indurated prostate was the most frequent finding (50%). The mean PSA was 33.9ng/mL: of the 131 patients, 80 (61.1%) had a malignant histology following biopsy, 47 (35.9%) were benign and four (3.0%) were prostate intraepithelial neoplasia (PIN). The low specificity of DRE in the diagnosis of prostate cancer requires that it should be combined with other diagnostic modalities such as PSA and TRUS-guided prostate biopsy. Thus government and health-care providers in resource-poor countries must strive to make these facilities available in order to improve prostate cancer diagnosis.
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Affiliation(s)
- Muhammed Ahmed
- Ahmadu Bello University Teaching Hospital – Surgery, Shika, Zaria, Kaduna State 810001, Nigeria
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28
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Hennis AJM, Hambleton IR, Wu SY, Skeete DHA, Nemesure B, Leske MC. Prostate cancer incidence and mortality in barbados, west indies. Prostate Cancer 2011; 2011:565230. [PMID: 22110989 PMCID: PMC3200283 DOI: 10.1155/2011/565230] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 01/27/2011] [Indexed: 01/08/2023] Open
Abstract
We describe prostate cancer incidence and mortality in Barbados, West Indies. We ascertained all histologically confirmed cases of prostate cancer during the period July 2002 to December 2008 and reviewed each death registration citing prostate cancer over a 14-year period commencing January 1995. There were 1101 new cases for an incidence rate of 160.4 (95% Confidence Interval: 151.0-170.2) per 100,000 standardized to the US population. Comparable rates in African-American and White American men were 248.2 (95% CI: 246.0-250.5) and 158.0 (95% CI: 157.5-158.6) per 100,000, respectively. Prostate cancer mortality rates in Barbados ranged from 63.2 to 101.6 per 100,000, compared to 51.1 to 78.8 per 100,000 among African Americans. Prostate cancer risks are lower in Caribbean-origin populations than previously believed, while mortality rates appeared to be higher than reported in African-American men. Studies in Caribbean populations may assist understanding of disparities among African-origin populations with shared heredity.
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Affiliation(s)
- Anselm J. M. Hennis
- Chronic Disease Research Centre, The University of the West Indies, Jemmott's Lane, St. Michael, Barbados
- Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY 11794-8036, USA
- Ministry of Health, Jemmott's Lane, Bridgetown, Barbados
- Faculty of Medical Sciences, The University of the West Indies, St. Michael, Barbados
| | - Ian R. Hambleton
- Chronic Disease Research Centre, The University of the West Indies, Jemmott's Lane, St. Michael, Barbados
| | - Suh-Yuh Wu
- Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY 11794-8036, USA
| | - Desiree H.-A. Skeete
- Faculty of Medical Sciences, The University of the West Indies, St. Michael, Barbados
| | - Barbara Nemesure
- Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY 11794-8036, USA
| | - M. Cristina Leske
- Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY 11794-8036, USA
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Wallace TA, Martin DN, Ambs S. Interactions among genes, tumor biology and the environment in cancer health disparities: examining the evidence on a national and global scale. Carcinogenesis 2011; 32:1107-21. [PMID: 21464040 DOI: 10.1093/carcin/bgr066] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cancer incidence and mortality rates show great variations across nations and between population groups. These variations are largely explained by differences in age distribution, diet and lifestyle, access to health care, cultural barriers and exposure to carcinogens and pathogens. Cancers caused by infections are significantly more common in developing than developed countries, and they overproportionally affect immigrant populations in the USA and other countries. The global pattern of cancer is not stagnant. Instead, it is dynamic because of fluctuations in the age distribution of populations, improvements in cancer prevention and early detection in affluent countries and rapid changes in diet and lifestyle in parts of the world. For example, increased smoking rates have caused tobacco-induced cancers to rise in various Asian countries, whereas reduced smoking rates have caused these cancers to plateau or even begin to decline in Western Europe and North America. Some population groups experience a disproportionally high cancer burden. In the USA and the Caribbean, cancer incidence and mortality rates are excessively high in populations of African ancestry when compared with other population groups. The causes of this disparity are multifaceted and may include tumor biological and genetic factors and their interaction with the environment. In this review, we will discuss the magnitude and causes of global cancer health disparities and will, with a focus on African-Americans and selected cancer sites, evaluate the evidence that genetic and tumor biological factors contribute to existing cancer incidence and outcome differences among population groups in the USA.
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Affiliation(s)
- Tiffany A Wallace
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-4258, USA
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Oladimeji O, Bidemi YO, Olufisayo JAY, Sola AO. Prostate Cancer Awareness, Knowledge, and Screening Practices among Older Men in Oyo State, Nigeria. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2010; 30:271-86. [DOI: 10.2190/iq.30.3.g] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Prostate cancer is the leading cause of cancer among Nigerian men. This study assessed the knowledge, awareness, and screening practices among older men regarding prostate cancer in Oyo State, Nigeria. A cross-sectional study used a multi-stage sampling technique to select 561 adult males. A semi-structured questionnaire was used. Respondents' median age is 60.0 years. Prostate cancer awareness was high [449 (80.0%)]. The overall mean knowledge of prostate cancer causation, treatment, and prevention was 5.8 (±3.0) out of a maximum of 16. Only 109 (19.4%) perceived themselves at risk of developing prostate cancer, but only 4.5% have ever been screened. Though knowledge and risk perception of prostate cancer were low, a majority of respondents (81.5%) were willing to be screened for the disease. Community-based prostate cancer educational interventions and provision of screening centers are needed for this group.
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Heyns CF. Is prostate cancer more common and more aggressive in African men? AFRICAN JOURNAL OF UROLOGY 2010. [DOI: 10.1007/s12301-008-0007-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Badmus TA, Adesunkanmi ARK, Yusuf BM, Oseni GO, Eziyi AK, Bakare TIB, Adetiloye JA, Badmus SA. Burden of prostate cancer in southwestern Nigeria. Urology 2010; 76:412-6. [PMID: 20451979 DOI: 10.1016/j.urology.2010.03.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 02/24/2010] [Accepted: 03/01/2010] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine the pattern of presentation, prevalent age, hospital incidence, and outcome of management of prostate cancer in our environment. METHOD Patients with histopathology evidence of prostate cancer managed between January 1991 and December 2007 were studied. Information entered into a pro-forma sheet and analyzed included the age of patients, clinical features, investigations, histopathology diagnosis, outcome of management, and duration of follow-up. RESULTS During the period, 189 patients aged 46-99 years (mean, 68.0; 9.8 SD) confirmed and managed for prostate cancer were studied. The average hospital incidence (2002-2004) was 182.5 per 10(5) male admissions with 15.1-month mean duration of symptoms. Most 178 (94.2%) patients presented with advanced diseases, with 1 or multiple complications in 172 (91.0%), obstructive lower urinary tract symptoms 156 (82.5%), distant metastasis 97 (51.3%), lower back pain 95 (50.3%), weight loss 95 (50.3%), hematuria 86 (45.5%), anemia 77 (40.7%), renal failure 74 (39.2%), and inability to walk 42 (22.2%). Eighty-nine (47.0%) patients were farmers, 111 (58.7%) indulged in alcohol, and 46 (24.3%) smoked cigarettes. Mean prostate-specific antigen results available in 53 patients was 106.0 ng/mL (187.2SD) and digital rectal examination was valuable in diagnosis. Adenocarcinoma (186 [98.4%]) was the main histopathology type and most patients 136 (71.9%) had bilateral orchidectomy with or without antiandrogens. Mean duration of follow-up was 83.7 weeks. CONCLUSIONS The burden of prostate cancer in our developing community is worrisome. It is prevalent between 46 and 99 years in our community. Presentation is late, often with urinary retention and other complications. In our setting, treatment is still essentially palliative with orchidectomy, which we found to be beneficial, acceptable, and the most affordable to our patients.
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Affiliation(s)
- Tajudeen A Badmus
- Department of Surgery; Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University; and Obafemi Awolowo University Teaching Hospital, Complex, Ile-Ife, Nigeria.
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Gupta D, Lammersfeld CA, Trukova K, Lis CG. Vitamin D and prostate cancer risk: a review of the epidemiological literature. Prostate Cancer Prostatic Dis 2009; 12:215-26. [PMID: 19350051 DOI: 10.1038/pcan.2009.7] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prostate cancer is the most commonly diagnosed cancer in the United States. Prostate cells contain vitamin D receptors as well as enzymes necessary for vitamin D metabolism. Vitamin D metabolites have an antiproliferative and a pro-differentiating effect on prostate cancer cell lines in vitro and in vivo. As a result, there has been an emerging interest in the potential role of vitamin D in the etiology of prostate cancer. This review summarizes all available epidemiological literature on the association between dietary vitamin D, circulating levels of vitamin D and sunlight exposure in relation to prostate cancer risk. To place these studies in context, we also provide some background information on vitamin D, such as its dietary sources, metabolism, optimal levels, hypovitaminosis and relationship with the prostate.
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Affiliation(s)
- D Gupta
- Cancer Treatment Centers of America, Midwestern Regional Medical Center, Zion, IL 60099, USA.
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Odedina FT, Akinremi TO, Chinegwundoh F, Roberts R, Yu D, Reams RR, Freedman ML, Rivers B, Green BL, Kumar N. Prostate cancer disparities in Black men of African descent: a comparative literature review of prostate cancer burden among Black men in the United States, Caribbean, United Kingdom, and West Africa. Infect Agent Cancer 2009; 4 Suppl 1:S2. [PMID: 19208207 PMCID: PMC2638461 DOI: 10.1186/1750-9378-4-s1-s2] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND African American men have the highest prostate cancer morbidity and mortality rates than any other racial or ethnic group in the US. Although the overall incidence of and mortality from prostate cancer has been declining in White men since 1991, the decline in African American men lags behind White men. Of particular concern is the growing literature on the disproportionate burden of prostate cancer among other Black men of West African ancestry in the Caribbean Islands, United Kingdom and West Africa. This higher incidence of prostate cancer observed in populations of African descent may be attributed to the fact that these populations share ancestral genetic factors. To better understand the burden of prostate cancer among men of West African Ancestry, we conducted a review of the literature on prostate cancer incidence, prevalence, and mortality in the countries connected by the Transatlantic Slave Trade. RESULTS Several published studies indicate high prostate cancer burden in Nigeria and Ghana. There was no published literature for the countries Benin, Gambia and Senegal that met our review criteria. Prostate cancer morbidity and/or mortality data from the Caribbean Islands and the United Kingdom also provided comparable or worse prostate cancer burden to that of US Blacks. CONCLUSION The growing literature on the disproportionate burden of prostate cancer among other Black men of West African ancestry follows the path of the Transatlantic Slave Trade. To better understand and address the global prostate cancer disparities seen in Black men of West African ancestry, future studies should explore the genetic and environmental risk factors for prostate cancer among this group.
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Affiliation(s)
| | | | - Frank Chinegwundoh
- Barts and The London NHS Trust and Newham University NHS Trust, London UK
| | | | - Daohai Yu
- H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | | | | | - Brian Rivers
- H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - B Lee Green
- H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Nagi Kumar
- H. Lee Moffitt Cancer Center, Tampa, Florida, USA
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Ukoli FA, Taher K, Egbagbe E, Lomotey M, Oguike T, Akumabor P, Osime U, Beech D. Association of self-reported consumption of cooked meat, fish, seafood and eggs with prostate cancer risk among Nigerians. Infect Agent Cancer 2009; 4 Suppl 1:S6. [PMID: 19208211 PMCID: PMC2638465 DOI: 10.1186/1750-9378-4-s1-s6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Flora A Ukoli
- Department of Surgery, Meharry Medical College, Nashville, TN 37208, USA.
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Odedina FT, Yu D, Akinremi TO, Renee Reams R, Freedman ML, Kumar N. Prostate Cancer Cognitive-Behavioral Factors in a West African Population. J Immigr Minor Health 2008; 11:258-67. [DOI: 10.1007/s10903-008-9212-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 11/20/2008] [Indexed: 11/24/2022]
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Ben-Shlomo Y, Evans S, Ibrahim F, Patel B, Anson K, Chinegwundoh F, Corbishley C, Dorling D, Thomas B, Gillatt D, Kirby R, Muir G, Nargund V, Popert R, Metcalfe C, Persad R. The risk of prostate cancer amongst black men in the United Kingdom: the PROCESS cohort study. Eur Urol 2008; 53:99-105. [PMID: 17368710 DOI: 10.1016/j.eururo.2007.02.047] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Accepted: 02/21/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES It is known that African American men have a greater risk of prostate cancer than white men. We investigated whether this was true for first-generation black Caribbean and black African men in the United Kingdom. METHODS A clinical cohort study design recruiting all cases of prostate cancer diagnosed over a 5-yr period and residing in defined areas of London and Bristol. We calculated the age-standardised incidence rates and relative risk for all black men, and black Caribbean and black African men versus white men. RESULTS Black men had higher age-adjusted rates of prostate cancer (166 per 100,000, 95% confidence interval [95%CI], 151-180 per 100,000) than white men (56.4 per 100,000, 95%CI, 53.3-59.5 per 100,000). The relative risks for all black, black Caribbean, and black African men were 3.09 (95%CI, 2.79-3.43; p<0.0001), 3.19 (95%CI, 2.85-3.56; p<0.0001) and 2.87 (95%CI, 2.34-3.53; p<0.0001), respectively. There was no strong evidence that the rates for black Caribbean differed from black African men. The higher risk in black men compared with white men was more apparent in younger age groups (p value for interaction<0.001). CONCLUSIONS Black men in the United Kingdom have substantially greater risk of developing prostate cancer compared with white men, although this risk is lower than that of black men in the United States. The similar rates in black Caribbean and black African men suggest a common genetic aetiology, although migration may be associated with an increased risk attributable to a gene-environment interaction.
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Affiliation(s)
- Yoav Ben-Shlomo
- Department of Social Medicine, University of Bristol, and Department of Urology, United Bristol Healthcare Trust, Southmead Hospital, Bristol, UK.
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Delongchamps NB, Singh A, Haas GP. Epidemiology of prostate cancer in Africa: another step in the understanding of the disease? Curr Probl Cancer 2007; 31:226-36. [PMID: 17543950 DOI: 10.1016/j.currproblcancer.2007.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Nicolas B Delongchamps
- Department of Urology, State University of New York Health Sciences center, Syracuse, New York, USA
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Kehinde EO, Akanji AO, Al-Hunayan A, Memon A, Luqmani Y, Al-Awadi KA, Varghese R, Bashir AA, Daar AS. Do differences in age specific androgenic steroid hormone levels account for differing prostate cancer rates between Arabs and Caucasians? Int J Urol 2006; 13:354-61. [PMID: 16734850 DOI: 10.1111/j.1442-2042.2006.01305.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Factors responsible for the low incidence of clinical prostate cancer in the Arab population remain unclear, but may be related to differences in androgenic steroid hormone metabolism between Arabs and other populations, especially as prostate cancer is believed to be androgen dependent. We therefore measured the levels of serum androgenic steroids and their binding proteins in Arab men and compared results obtained with values reported for Caucasian populations to determine if any differences could at least partially account for differences in incidence of prostate cancer rates between the two populations. METHODS Venous blood samples were obtained from 327 unselected apparently healthy indigenous Arab men (Kuwaitis and Omanis) aged 15-79 years. Samples were also obtained from 30 Arab men with newly diagnosed prostate cancer. Serum levels of total testosterone (TT), sex hormone binding globulin (SHBG), derived free androgen index (FAI); adrenal C19 -steroids, dehydroepiandrosterone sulfate (DHEAS) and androstenedione (ADT) were determined by chemiluminescent immunoassay. Age specific reference intervals, mean and median for each analyte were determined. Frequency distribution pattern for each hormone was plotted. The reference range for hormones with normal distribution was mean +/- 2SD and 2.5-97.5% for those with non-normal distribution. The mean serum levels of the hormones in Arab men with prostate cancer were compared with values in healthy age-matched Arab men. RESULTS There was a significant decrease between the 21-29 years age group and the 70-79 years age group for TT (-38.77%), DHEAS (-70%), ADT (-36%) and FAI (-63.25%), and an increase for SHBG (+64%). The calculated reference ranges are TT (2.73-30.45 nmol/L), SHBG (6.45-65.67 nmol/L), FAI (14.51-180.34), DHEAS (0.9-11.0 micromol/L) and ADT (0.54-4.26 ng/mL). The mean TT, SHBG, DHEAS and ADT in Arab men were significantly lower than those reported for Caucasians especially in the 21-29 years age group. Arab men with newly diagnosed prostate cancer had higher serum TT (P < 0.7), ADT (P < 0.2), SHBG (P < 0.2) and lower DHEAS (P < 0.008) compared to aged matched controls. CONCLUSIONS Serum TT, SHBG, DHEAS and ADT levels are significantly lower in Arab men compared to those reported for Caucasian men, especially in early adulthood. Arab men with newly diagnosed prostate cancer have higher circulating androgens compared to healthy controls. We suggest that low circulating androgens and their adrenal precursors in Arab men when compared to Caucasians may partially account for the relatively lower risk for prostate cancer among Arab men.
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Affiliation(s)
- Elijah O Kehinde
- Department of Surgery (Division of Urology), Faculty of Medicine, Kuwait University, Kuwait.
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Kehinde EO, Akanji AO, Memon A, Bashir AA, Daar AS, Al-Awadi KA, Fatinikun T. Prostate Cancer Risk: The Significance of Differences in Age Related Changes in Serum Conjugated and Unconjugated Steroid Hormone Concentrations Between Arab and Caucasian Men. Int Urol Nephrol 2006; 38:33-44. [PMID: 16502050 DOI: 10.1007/s11255-005-3619-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Factors responsible for the low incidence of clinical prostate cancer (3-8/100,000 men/year) in the Arab population remain unclear, but may be related to changes in steroid hormone metabolism. We compared the levels of serum conjugated and unconjugated steroids between Arab and Caucasian populations, to determine if these can provide a rational explanation for differences in incidence of prostate cancer between the two populations. PATIENTS/METHOD Venous blood samples were obtained from 329 unselected apparently healthy indigenous Arab men (Kuwaitis and Omanis) aged 15-80 years. Samples were also obtained from similar Arab men with newly diagnosed prostate cancer or benign prostatic hyperplasia (BPH). The samples were taken between 8:00 am and 12:00 noon. Serum levels of total testosterone, (TT), sex hormone binding globulin (SHBG), free androgen index (FAI); adrenal C19-steroids, dehydroepiandrosterone sulphate (DHEAS) and androstenedione (ADT) were determined using Immulite kits (Diagnostic Systems Laboratories Inc, Webster Texas, USA). The results obtained in Arab men were compared with those reported for similarly aged Chinese, German and White USA men. RESULTS In all four ethnic groups, median TT and FAI declined with age, while SHBG increased with age. However, the mean TT and SHBG was significantly lower (p < 0.01) and the FAI significantly higher in Arab men (p < 0.01) compared to German men only in 21-30 years age group. In the other age groups the levels of TT and SHBG were higher in the Germans but the differences were not statistically significant. In all the racial groups serum levels of DHEAS and ADT reached a peak by about 20 years of life, and then declined progressively. The mean DHEAS in American Caucasians aged 20-29 years was 11.4 micromol/l compared to 6.22 micromol/l in the Arabs (p < 0.001). The mean DHEAS in USA Caucasians aged 70-79 years was 2.5 micromol/l compared to 1.8 micromol/l (p < 0.03) in the Arabs. There was no significant difference in mean serum levels of DHEAS between German and USA men. Similarly, there was no significant difference in the level of the hormones between Arab and Chinese men. Arab men with newly diagnosed prostate cancer had high serum TT, SHBG and DHEAS compared to those without the disease. CONCLUSIONS The mean TT and SHBG was significantly lower in Arab men compared to Caucasian men especially in early adulthood. Caucasians have significantly higher serum levels of the precursor androgens DHEAS and ADT especially in early adulthood compared to Arab men. These observations of low circulating androgens and their adrenal precursors in Arab men may partially account for the decreased risk for prostate cancer among Arab men.
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Affiliation(s)
- E O Kehinde
- Faculty of Medicine, Department of Surgery, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait.
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Jackson FLC. Illuminating cancer health disparities using ethnogenetic layering (EL) and phenotype segregation network analysis (PSNA). JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2006; 21:S69-79. [PMID: 17020506 DOI: 10.1207/s15430154jce2101s_13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Resolving cancer health disparities continues to befuddle simplistic racial models. The racial groups alluded to in biomedicine, public health, and epidemiology are often profoundly substructured. METHODS EL and PSNA are computational assisted techniques that focus on microethnic group (MEG) substructure. RESULTS Geographical variations in cancer may be due to differences in MEG ancestry or similar environmental exposures to a recognized carcinogen. Examples include breast and prostate cancers in the Chesapeake Bay region and Bight of Biafra biological ancestry, hypertension and stroke in the Carolina Coast region and Central African biological ancestry, and pancreatic cancer in the Mississippi Delta region and dietary/medicinal exposure to safrol from Sassafras albidum.
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Affiliation(s)
- Fatimah L C Jackson
- Department of Anthropology, Genomic Models Research Group, Biological Anthropology Research Laboratory, MD 20742, USA.
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Heyns CF, Lecuona AT, Trollip GS. Prostate cancer: Prevalence and treatment in African men. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.jmhg.2005.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
This article has discussed the increased incidence and disproportionately increased mortality of prostate cancer among African American men.Although the exact reasons are unknown, genetics may play a role, in addition to health care practices. Morbidity from other disease states, such as diabetes, obesity, or hypertension, may influence the overall survival of patients with prostate cancer. Current research tools will continue to explore biologic differences between the races; however, socioeconomic status and access to health care must not be overlooked. Several studies have demonstrated that similar disease stages and equal access to health care will result in similar outcomes. It is recognized that screening for prostate cancer will remain a controversial topic. Several influential professional societies recommend against screening and other professional societies endorse screening. Large-scale trials are currently underway hoping to answer this critical question. Since the advent of current screening tools, however, it seems that the overall mortality for prostate cancer has decreased and this cannot be ignored. Certainly, screening programs and clinical trials have traditionally had difficulty in recruiting minority participants, although more recent trials seem to be finding success. A primary care physician who is viewed as competent by their patients can certainly have a positive impact on their African American patients' willingness to participate in studies and screening programs. Most importantly, on the individual level, primary care physicians can provide a great service to their minority patients by offering educational materials on prostate cancer and by offering screening to qualified patients. The current American Urologic Association and National Cancer Institute guidelines recommend offering screening to all men age 50 and above. African American men or men with a first-degree relative with prostate cancer should be offered screening beginning at age 40. Proper screening consists of both a digital rectal examination to assess for asymmetry or nodules of the prostate and a serum PSA. Current recommendations are that individuals with a serum PSA greater than 4 ng/mL ora prostate nodule or asymmetric prostate should be referred to an urologist,where a biopsy can be performed easily in the office setting.The PSA cutoff of 4 has recently been questioned. A study by Thompson et al [31] evaluated 2950 men with a PSA of 4 or less with prostate biopsy.They found that the risk of prostate cancer in men with a PSA between 3.1 and 4 was 26.9% and that 25% of these men with prostate cancer had high-grade disease. All men found to have cancer had T1 disease. The clinical relevance of this surprisingly high rate of prostate cancer in men with a normal PSA is yet to be determined and is pending in studies on the ultimate effect of screening on mortality from prostate cancer. This information is not intended to confuse the issue, but intended to provide the most up-to-date information and allow for the best clinical decision making by the primary care physician. What can currently be recommended is if a patient is concerned about his possibility of having prostate cancer despite a normal PSA, a referral to an urologist to at least further discuss the issue may be in order. This may be especially true if the patient is African American or has a family history of prostate cancer at an early age.
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Affiliation(s)
- Dan B French
- Department of Urology, University of Texas Health Science Center at San Antonio, MC 7845, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
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Fournier G, Valeri A, Mangin P, Cussenot O. Cancer de la prostate. Épidémiologie. Facteurs de risques. Anatomopathologie. ACTA ACUST UNITED AC 2004; 38:187-206. [PMID: 15570704 DOI: 10.1016/j.anuro.2004.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prostate cancer (prostate adenocarcinoma) has become an important concern in terms of public health these past fifteen years; recent French epidemiological data revealed 10,104 deaths due to this disease in 2000. The two main factors involved are the serum prostatic specific antigen (PSA), routinely used since late 1980's and which allows early diagnosis (before symptom onset), and the lengthened duration of life. Such cancer is rare before the age of 50, but its frequency increases with age, making it the most frequent type of cancer in French men. Although the aetiology of this disease is unknown, the ethnic origin, and a familial history of prostate or breast cancer are known risk factors. Predisposing genes to such hereditary types remain to be identified. Other genetic factors (polymorphisms), combined with environmental factors such as nutrition, have been incriminated, which is likely to explain the geographical variations of this affection. At the molecular level, the mechanisms involved in the tumoral initiation and progression remain unclear. Various genetic alterations have been identified among the genome of cancerous cells, at various stages of the affection: intraepithelial neoplasia, localized, locally advanced, metastatic or hormone refractory stage -, hormonal escape). However, the precise sequence and nature of the complex molecular events remain to be determined prior to their routine utilisation in the determination of subjects at risk, or as prognostic factors, and even as therapeutic targets. The anatomopathology is a key for the diagnosis. Intraepithelial neoplasia is the pre-cancerous lesion observed in most adenocarcinomas; these are localized in the peripheral part of the prostate gland in 70% of the cases. Gleason's classification is the current gold standard for the determination of tumoral aggressiveness and categorisation of the adenocarcinomas which are basically heterogeneous (coexistence of tumors cells with different degrees of differenciation in the same tumor). This anatomopathological classification allows distinguishing the tumours in terms of potential progressiveness and prognosis, and hence, to orientate the therapeutic strategy in case of localised or locally advanced prostate cancer.
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Affiliation(s)
- G Fournier
- Service d'urologie, Centre hospitalier universitaire de Brest, hôpital de la Cavale Blanche, boulevard Tanguy-Prigent, 29609 Brest, France.
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Chen AC, MacChia RJ, Conway F, Magai C, Desai M, Neugut AI. Prostate-specific antigen, sex steroid hormones, and the insulin-like growth factor axis in U.S.-born, Jamaican, and Haitian black men: A pilot study. Urology 2004; 64:522-7. [PMID: 15351583 DOI: 10.1016/j.urology.2004.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2004] [Accepted: 04/05/2004] [Indexed: 11/18/2022]
Abstract
OBJECTIVES African-Caribbean men have a risk of prostate cancer comparable to that of African-American men. To begin exploring potential risk factors for prostate cancer in these high-risk black subgroups, we conducted a pilot study in Brooklyn, New York, a community with large numbers of African-Americans and immigrants from Jamaica and Haiti. METHODS Black men, 35 to 65 years of age, who were born in the United States, Jamaica, or Haiti were recruited in Brooklyn. The subjects' serum samples were analyzed for prostate-specific antigen (PSA) and the following hormones, which may be related to prostate cancer: testosterone, sex hormone-binding globulin, 3alpha-androstanediol glucuronide, insulin-like growth factor-1 (IGF-1), and IGF-binding protein-3 (IGFBP-3). Subgroup differences in PSA and hormonal levels, adjusted for relevant covariates, were explored using analysis of variance techniques. RESULTS For 3 months, we recruited 21 U.S.-born, 20 Jamaican-born, and 24 Haitian-born black men using various methods. The mean age-adjusted PSA level was 1.04 ng/mL in the U.S.-born men, 1.09 ng/mL in the Jamaican-born men, and 0.85 ng/mL in the Haitian-born men (P = 0.55). The mean age-adjusted hormone levels, as well as testosterone/sex hormone-binding globulin and IGF-1/IGFBP-3 ratios, also were not significantly different statistically across the subgroups. CONCLUSIONS It is feasible to conduct epidemiologic studies of prostate cancer in these high-risk black subgroups in Brooklyn. Our preliminary data suggest that the serum levels of PSA and potential hormonal risk factors are similar among U.S.-born, Jamaican-born, and Haitian-born black men. Larger follow-up studies are being planned to confirm these findings.
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Affiliation(s)
- Allen C Chen
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA
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47
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Abstract
Ahead of Print article withdrawn by publisher.
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Affiliation(s)
- Wael A Sakr
- 1Department of Pathology, Wayne State University, Detroit, MI, USA
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48
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Freeman VL, Coard KCM, Wojcik E, Durazo-Arvizu R. Use of the Gleason system in international comparisons of prostatic adenocarcinomas in blacks. Prostate 2004; 58:169-73. [PMID: 14716742 DOI: 10.1002/pros.10323] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Comparisons of prostate cancer in blacks living in different countries can shed light on factors responsible for high rates of the disease among blacks in America. Since the prognostic value of the Gleason grading system is well established, we assessed agreement between pathologists in countries where black populations of the African Diaspora reside. METHODS Three genitourinary pathologists at hospitals in Nigeria, Jamaica, and the US independently assessed sextant biopsies from 12 patients. Gleason sum and percentage involvement were recorded, and a percent-weighted average calculated. Agreement under different groupings was evaluated using the kappa statistic generalized to three raters. RESULTS Agreement was significant for individual sums (kappa = 0.3317, P = 0.0173), sums grouped as well (2-4), moderately (5-6), and poorly differentiated (7-10) (kappa = 0.2437, P < 0.0001) and other groupings. Agreement between at least two raters was 91.7-100%; complete agreement was 41.7-66.7%. CONCLUSIONS The Gleason system is feasible and practical for international studies of prostate cancer among blacks from contrasting environments.
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Affiliation(s)
- Vincent L Freeman
- Department of Medicine, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA.
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Angwafo FF, Zaher A, Befidi-Mengue R, Wonkam A, Takougang I, Powell I, Murphy G. High-grade intra-epithelial neoplasia and prostate cancer in Dibombari, Cameroon. Prostate Cancer Prostatic Dis 2003; 6:34-8. [PMID: 12664062 DOI: 10.1038/sj.pcan.4500587] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2002] [Revised: 03/26/2002] [Accepted: 04/03/2002] [Indexed: 11/09/2022]
Abstract
High-grade prostatic intra-epithelial neoplasia (HGPIN) occurs a decade earlier in men of African descent in the US and Brazil, compared to white men. Prostate cancer incidence and mortality is worse in the African-American than in US white men. Sub-Saharan Africa was thought to be a low incidence area. This disparity has been attributed to lifestyle factors such as diet. We report the results of prostatic biopsies, from an ongoing national prostate cancer survey. One hundred and eleven men aged 40 y and over were recruited for medical interview (AUA symptom score), prostate specific antigen (PSA) assay and digital rectal examination (DRE). Between six and 10 cores of random digitally guided needle biopsies were performed on 24 subjects that had either suspicious prostates on digital rectal examination +/ or PSA > or =4 ng/ml. All lesions of the prostate were described on routine histopathology. The Gleason score and proportion of tissue involved with cancer, was determined. Eight men had benign prostatic hyperplasia (BPH), six had cancer, another six had low grade intra-epithelial neoplasia, two had HGPIN, there was one case of BPH and chronic prostatitis and one case of chronic prostatitis only. The cancer patients were aged 58-75 y (mean 66.93 y). Gleason scores ranged from 5 to 9, there was one score of 3. Cancer made up 20-80% tissue samples. HGPIN was found in two cases (mean age 58 y). Significant prostate cancer and the pre-cancerous lesion HGPIN exist in Dibombari, Cameroon. The purported low incidence of prostate cancer may reflect cultural and economic barriers to health care.
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Affiliation(s)
- F F Angwafo
- The National Health Survey Team For Chronic Diseases, National Epidemiology Board, Ministry of Public Health, Yaounde, Cameroon.
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Ukoli F, Osime U, Akereyeni F, Okunzuwa O, Kittles R, Adams-Campbell L. Prevalence of elevated serum prostate-specific antigen in rural Nigeria. Int J Urol 2003; 10:315-22. [PMID: 12757603 DOI: 10.1046/j.1442-2042.2003.00633.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recent hospital and cancer registry data show increasing prostate cancer incidence in Nigeria, which was previously regarded as a low incidence region. This study investigates the prevalence of prostate cancer risk in a previously unscreened cohort of rural Nigerians. METHODS Rural Nigerian men, 40 years and older, were screened by serum prostate-specific antigen (PSA) and digital rectal examination (DRE) and those with PSA >/= 4 ng/mL and/or abnormal DRE were referred for prostate biopsy. RESULTS Of 200 consecutive men invited, 151 (75.5%) presented for screening, the mean age was 56.45 + 15.1 and 95 (61.6%) were >/= 50 years of age. Of the 140 who consented to a blood test, PSA correlated with age (r = 0.3, P < 0.01), 14 (10.0%) had abnormal PSA >/= 4 ng/mL, increasing from 3 (3.6%) in men < 60 years to 4 (50%) in men >/= 80 years. The rate was 13 (15.7%) for men >/= 50 years and there was no evidence of increased incidence of prostatitis in the community. Mean (median) PSA in ng/mL increased from 1.17 (0.60) in the youngest to 13.75 (4.45) in the oldest cohort. Of those who accepted DRE, 38 (29.0%) had an enlarged prostate, including two who had nodular prostate, one-third with symptoms, increasing from 4 (5.4%) in those < 50 years to 6 (75.0%) in men >/= 80 years. The proportion of men with PSA >/= 4 ng/mL among those with enlarged vs normal prostate is 27.0 to 3.4%, P < 0.001, and the pattern was similar for men >/= 60 years and those < 60 years of age. The 40 (32.0%) men referred for prostate biopsy defaulted mainly because they did not fully understand the need for further investigation because they were symptom free or afraid of the possible side-effects of the procedure or diagnosis of cancer. CONCLUSION The proportion of men with PSA >/= 4 ng/mL is comparable to that of previously unscreened populations with high incidence of prostate cancer such as African-American men. A larger study is required to confirm these findings and intensify efforts to determine the prostate cancer detection rate by biopsy in this population. A prostate cancer awareness and education campaign will be useful in this community.
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Affiliation(s)
- Flora Ukoli
- Cancer Center and National Human Genome Center, Howard University, Washington DC, USA.
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