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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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Gosein MA, Narinesingh D, Motilal S, Ramkissoon AP, Goetz CM, Sadho K, Mosodeen MD, Banfield R. Biparametric MRI prior to Radical Radiation Therapy for Prostate Cancer in a Caribbean Population: Implications for Risk Group Stratification and Treatment. Radiol Imaging Cancer 2020; 2:e200007. [PMID: 33778724 PMCID: PMC7983799 DOI: 10.1148/rycan.2020200007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/20/2020] [Accepted: 04/07/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE To assess risk-group migration and subsequent management change following biparametric MRI using a risk-stratified approach in a group of Caribbean men with prostate adenocarcinoma being offered external beam radiation therapy (EBRT). MATERIALS AND METHODS This retrospective study assessed the biparametric MRI findings in men who opted for EBRT from January 2018 to June 2019 (n = 79; mean age, 67.9 years ± 6.2 [standard deviation]). Serum prostate-specific antigen level, digital rectal examination findings, histologic grade group (GG) from transrectal US-guided biopsy, prior androgen deprivation therapy (ADT), and any prior CT results were used to stratify patients into low-, intermediate-, and high-risk groups, according to the National Comprehensive Cancer Network risk categories. Risk-group stratification prior to MRI separated patients into low- (seven of 79 [8.9%]), intermediate- (36 of 79 [45.6%]) and high-risk (36 of 79 [45.6%]) groups. Following MRI, any risk group (low, intermediate, high, nodal involvement, and metastatic disease) or oncologic management changes were recorded. Multivariable binary logistic regression analyses were used to assess predictor of upgrade status, with adjustment for demographic covariates jointly. RESULTS Following MRI, 30 of 79 (38.0%) patients had risk-group upshifts compared with their original assessment. Patients were recategorized into low risk (one of 79, 1.3%), intermediate risk (19 of 79, 24.1%), high risk (51 of 79, 64.6%), nodal involvement (one of 79, 1.3%), and metastatic disease (seven of 79, 8.9%). From the original groupings, there were six of seven (85.7%) from the low group, 18 of 36 (50.0%) from the intermediate group, and six of 36 (16.7%) from the high group that had risk group upward shifts. There was no association with GG: GG2 versus GG1, P = .53; GG3 versus GG1, P = .98; or prior ADT (P = .37) and the adjusted odds of risk-group upshifts. MRI findings resulted in treatment plan modification for 39 of 79 (49.4%) men overall. CONCLUSION Prostate MRI should be considered for patients in high-risk populations prior to EBRT because upstaging from MR image assessment may have implications for modification of treatment.Keywords: MR-Imaging, Prostate, Radiation Therapy© RSNA, 2020See the commentary by Davenport and Shankar in this issue.
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Davenport MS, Shankar PR. Biparametric Prostate MRI Influencing Care Patterns in a Caribbean Population. Radiol Imaging Cancer 2020; 2:e200096. [PMID: 33779668 PMCID: PMC7983729 DOI: 10.1148/rycan.2020200096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Matthew S. Davenport
- From the Departments of Radiology (M.S.D., P.R.S.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109
| | - Prasad R. Shankar
- From the Departments of Radiology (M.S.D., P.R.S.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109
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Badal S, Aiken W, Morrison B, Valentine H, Bryan S, Gachi A, Ragin C. Disparities in prostate cancer incidence and mortality rates: Solvable or not? Prostate 2020; 80:3-16. [PMID: 31702061 PMCID: PMC8378246 DOI: 10.1002/pros.23923] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/18/2019] [Indexed: 12/21/2022]
Abstract
Prostate cancer (PCa) is recognized as a disease possessing not only great variation in its geographic and racial distribution but also tremendous variation in its potential to cause morbidity and death and it, therefore, ought not to be considered a homogenous disease entity. Morbidity and death from PCa are disproportionately higher in men of African ancestry (MAA) who are generally observed to have more aggressive disease and worse outcomes following treatment compared to men of European ancestry (MEA). The higher rates of PCa among MAA relative to MEA appear to be multifactorial and related to inherent differences in biological aggressiveness; a continued lack of awareness of the disease and methods of prevention; a lower prevalence of screen-detected PCa; comparatively lower access to quality healthcare as well as systemic and institutionalized disparities in the administration of optimal care to MAA in developed countries such as the United States of America where high-quality care is available. Even when access to quality healthcare is assured in equal access settings, it appears that MAA still have worse outcomes after PCa treatment stage-for-stage and grade-for-grade compared to MEA, suggesting that, inherent racial, ethnic and biological differences are paramount in predicting poor outcomes. This review has explored the different contributing factors to the current disparities in PCa incidence and mortality rates with emphasis on the incongruence in how research has been conducted in understanding the disease towards developing therapies.
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Affiliation(s)
- Simone Badal
- Department of Basic Medical Sciences, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica
| | - William Aiken
- Department of Surgery, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica
| | - Belinda Morrison
- Department of Surgery, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica
| | - Henkel Valentine
- Department of Basic Medical Sciences, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica
| | - Sophia Bryan
- Department of Basic Medical Sciences, Faculty of Medical Sciences, University of the West Indies, Kingston, Jamaica
| | - Andrew Gachi
- Department of pathology, Aga Khan University Hospital, 3 Avenue, Parklands, Nairobi, Kenya
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
- African Caribbean Cancer Consortium
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King-Okoye M, Arber A, Faithfull S. Beliefs that contribute to delays in diagnosis of prostate cancer among Afro-Caribbean men in Trinidad and Tobago. Psychooncology 2019; 28:1321-1327. [PMID: 30953381 PMCID: PMC6617795 DOI: 10.1002/pon.5085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/21/2019] [Accepted: 03/13/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this study was to explore Trinidad and Tobago (TT) men's prediagnosis experiences of prostate cancer (PCa). This study is part of a wider project that examined men and their partners' experiences of routes to diagnosis for PCa in TT. METHODS Men (n = 51) were voluntarily recruited to semi-structured interviews from four centres. Data were analysed following principles of grounded theory. RESULTS Major barriers to medical help seeking were highlighted as lack of knowledge and awareness of the prostate gland and symptoms of PCa, the digital rectal exam (DRE), prostate-specific antigen (PSA), cultural and religious beliefs, and hegemonic masculinity norms and nonreporting of bodily changes to GPs. Fear of DRE, distrust in providers, and misinterpretation of bodily changes as related to ageing and diabetes mellitus also contributed to delays towards seeking medical help. Men's interactions with pharmacists and traditional healers lengthened the time taken to consult with health care providers for prostate concerns. CONCLUSIONS TT men's PCa prediagnosis experiences are important to unearth barriers and facilitators to care along routes to diagnosis for this disease. This can help target specific health promotion strategies to motivate men to seek medical care for symptoms in a timely manner.
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Affiliation(s)
| | - Anne Arber
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Sara Faithfull
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Joachim C, Ulric-Gervaise S, Dramé M, Macni J, Escarmant P, Véronique-Baudin J, Vinh-Hung V. Long-term survival of patients with prostate cancer in Martinique: Results of a population-based study. Cancer Epidemiol 2019; 59:193-198. [PMID: 30825842 DOI: 10.1016/j.canep.2019.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Martinique has one of the highest incidences of prostate cancer (PCa) worldwide. We analysed overall survival (OS) among patients with PCa in Martinique, using data from a population-based cancer registry between 2005 and 2014. METHODS The log-rank test was used to assess the statistical differences between survival curves according to age at diagnosis, risk of disease progression including Gleason score, stage at diagnosis and Prostate Specific Antigen (PSA). A multivariable Cox model was constructed to identify independent prognostic factors for OS. RESULTS A total of 5045 patients were included with a mean age at diagnosis of 68.1±9.0 years [36.0 - 98.0 years]. Clinical stage was analysed in 4999 (99.1% of overall), 19.5% were at low risk, 34.7% intermediate and 36.9% at high risk. In our study, 8.9% of patients with available stage at diagnosis, were regional/metastatic cancers. Median PSA level at diagnosis was 10.4 ng/mL. High-risk PCa was more frequent in patients aged 65-74 and ≥75 years as compared to those aged <65 years (36.6% and 48.8% versus 28.7% respectively; p<0.0001). One-year OS was 96.3%, 5-year OS was 83.4 and 10-year OS was 65.0%. Median survival was not reached in the whole cohort. High-risk PCa (HR=2.32; p<0.0001), regional/metastatic stage (HR= 9.51; p<0.0001) and older age (65-74 and ≥75 years - respectively HR=1.70; and HR=3.38), were independent prognostic factors for OS (p<0.0001). CONCLUSION This study provides long term data that may be useful in making cancer management decisions for patients with PCa in Martinique.
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Affiliation(s)
- Clarisse Joachim
- UF 1441 Registre Général des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie Pathologie, CHU de Martinique, 97200, Fort-de-France, Martinique.
| | - Stephen Ulric-Gervaise
- UF 1441 Registre Général des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie Pathologie, CHU de Martinique, 97200, Fort-de-France, Martinique
| | - Moustapha Dramé
- UF 3163, Unité de soutien méthodologique à la Recherche, Délégation de la Recherche et de l'innovation, CHU Martinique, 97200, Fort-de-France, Martinique
| | - Jonathan Macni
- UF 1441 Registre Général des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie Pathologie, CHU de Martinique, 97200, Fort-de-France, Martinique
| | - Patrick Escarmant
- Pôle de Cancérologie Hématologie Urologie Pathologie, CHU de Martinique, 97200, Fort-de-France, Martinique
| | - Jacqueline Véronique-Baudin
- UF 1441 Registre Général des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie Pathologie, CHU de Martinique, 97200, Fort-de-France, Martinique
| | - Vincent Vinh-Hung
- Pôle de Cancérologie Hématologie Urologie Pathologie, CHU de Martinique, 97200, Fort-de-France, Martinique
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Joachim C, Veronique-Baudin J, Ulric-Gervaise S, Macni J, Almont T, Pierre-Louis O, Godaert L, Drame M, Novella JL, Farid K, Vinh-Hung V, Escarmant P. Pattern of care of prostate cancer patients across the Martinique: results of a population-based study in the Caribbean. BMC Cancer 2018; 18:1130. [PMID: 30445934 PMCID: PMC6240273 DOI: 10.1186/s12885-018-5047-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/06/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The French West-Indies rank first for both prostate cancer incidence and mortality rates. Analyzing diagnostic and therapeutic procedures among patients with prostate cancer, using data from a population-based cancer registry, is essential for cancer surveillance and research strategies. METHODS This retrospective observational cohort study was based on data from the Martinique Cancer Registry. Records of 452 patients diagnosed with prostate cancer in 2013 were retrieved from the registry. Data extracted were: socio-demographic and clinical characteristics, circumstances of diagnosis, PSA level at diagnosis, Gleason score and risk of disease progression. Stage at diagnosis and patterns of care among prostate cancer patients were analyzed. RESULTS Mean age at diagnosis was 67 ± 8 years; 103 (28.5%) were symptomatic at diagnosis. Digital rectal exam was performed in 406 (93.8%). Clinical stage was available in 385 (85.2%); tumours were localized in 322/385 (83.6%). Overall, 17.9% were at low risk, 36.4% at intermediate and 31.9% at high risk; 13.8% were regional/metastatic cancers. Median PSA level at diagnosis was 8.16 ng/mL (range 1.4-5000 ng/mL). A total of 373 patients (82.5%) received at least one treatment, while 79 (17.5%) had active surveillance or watchful waiting. Among patients treated with more than one therapeutic strategy, the most frequent combination was external radiotherapy with androgen deprivation (n = 102, 22.6%). CONCLUSIONS This study provides detailed data regarding the quality of diagnosis and management of patients with prostate cancer in Martinique. Providing data on prostate cancer is essential for the development of high-priority public health measures for the Caribbean.
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Affiliation(s)
- Clarisse Joachim
- CHU Martinique, UF1441 Registre des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie Pathologie, CS 90632, 97200, Fort-de-France, Martinique, France.
| | - Jacqueline Veronique-Baudin
- CHU Martinique, UF1441 Registre des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie Pathologie, CS 90632, 97200, Fort-de-France, Martinique, France
| | - Stephen Ulric-Gervaise
- CHU Martinique, UF1441 Registre des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie Pathologie, CS 90632, 97200, Fort-de-France, Martinique, France
| | - Jonathan Macni
- CHU Martinique, UF1441 Registre des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie Pathologie, CS 90632, 97200, Fort-de-France, Martinique, France
| | - Thierry Almont
- CHU Toulouse Paule de Viguier, Groupe de recherche en fertilité humaine EA 3694, Toulouse, France.,Groupe d'Étude, de Formation et de Recherche en Andrologie, Urologie et Sexologie Médecine de la Reproduction, Toulouse, France
| | - Olivier Pierre-Louis
- CHU Martinique, Pôle de Cancérologie, Hématologie Urologie Pathologie, 97200 Fort-de-France, Martinique, France
| | - Lidvine Godaert
- CHU de Martinique, Pôle de Gériatrie, 97200 Fort-de-France, Martinique, France
| | - Moustapha Drame
- CHU de Reims, Pôle Recherche et Santé publique, 51100 Reims, France
| | | | - Karim Farid
- CHU Martinique, Pole d'imagerie Médicale Service de Médecine nucléaire, 97200 Fort-de-France, Martinique, France
| | - Vincent Vinh-Hung
- CHU MARTINIQUE, Pôle de Cancérologie Hématologie Urologie Pathologie, 97200 Fort-de-France, Martinique, France
| | - Patrick Escarmant
- CHU MARTINIQUE, Pôle de Cancérologie Hématologie Urologie Pathologie, 97200 Fort-de-France, Martinique, France
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