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Pumpalova YS, Ramakrishnan A, May M, Pentz A, Minkowitz S, Doherty S, Singh E, Chen WC, Rebbeck TR, Neugut AI, Joffe M. Biochemical progression free and overall survival among Black men with stage IV prostate cancer in South Africa: Results from a prospective cohort study. Cancer Med 2024; 13:e6739. [PMID: 38158645 PMCID: PMC10807684 DOI: 10.1002/cam4.6739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Men of African descent are disproportionately affected by prostate cancer (PCa), and many have metastatic disease at presentation. In South Africa (SA), androgen deprivation therapy (ADT) is the first-line treatment for stage IV PCa. OBJECTIVE To identify predictors of overall survival (OS) in Black South African men with stage IV PCa treated with ADT. DESIGN, SETTING, AND PARTICIPANTS Men diagnosed with prostate cancer (3/22/2016-10/30/2020) at Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg, were recruited for the Men of African Descent with Cancer of the Prostate study. We included men with newly diagnosed stage IV PCa treated with ADT who had a prostate-specific antigen (PSA) level drawn prior to initiation of ADT and had ≥1 PSA drawn ≥12 weeks after ADT start. OUTCOMES MEASURES AND STATISTICAL ANALYSIS We used Kaplan-Meier statistics to estimate OS and Cox regression models to identify predictors of OS. RESULTS AND LIMITATIONS Of the 1097 men diagnosed with prostate cancer, we included 153 men with stage IV PCa who received ADT and met PSA requirements. The median age was 68.0 years (interquartile range 64-73 years). Median OS from time of ADT initiation was 3.39 years (95% confidence interval (CI): 3.14%-noncalculable), while biochemical progression-free survival was 2.36 years (95% CI: 2.03%-3.73%). Biochemical progression (HR 3.52, 95% CI: 1.85%-6.70%), PSA nadir level >4 ng/mL (HR 3.77, 95% CI: 1.86%-7.62%), alkaline phosphatase level at diagnosis >150 IU/dL (HR 3.09, 95% CI: 1.64%-5.83%), and hemoglobin at diagnosis <13.5 g/dL (HR 2.90, 95% CI: 1.28%-6.56%) were associated with worse OS. CONCLUSIONS In this study, we identified factors associated with poor OS among Black South African men with stage IV PCa treated with ADT. These factors may be useful in identifying patients for upfront treatment escalation, including the use of docetaxel chemotherapy or escalation of therapy at the time of biochemical progression. PATIENT SUMMARY In this study, we found that high alkaline phosphatase level, anemia at diagnosis, and high PSA nadir after initiation of androgen deprivation therapy are associated with worse overall survival among Black South African men treated with androgen deprivation therapy for metastatic prostate cancer.
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Affiliation(s)
- Yoanna S. Pumpalova
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia UniversityNew York CityNew YorkUSA
| | - Adarsh Ramakrishnan
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew York CityNew YorkUSA
| | - Michael May
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia UniversityNew York CityNew YorkUSA
| | - Audrey Pentz
- Strengthening Oncology Services Research Unit, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Shauli Minkowitz
- Division of Urology, Department of Surgery, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sean Doherty
- Division of Urology, Department of Surgery, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Elvira Singh
- National Cancer RegistryNational Health Laboratory ServiceJohannesburgSouth Africa
| | - Wenlong Carl Chen
- Strengthening Oncology Services Research Unit, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- National Cancer RegistryNational Health Laboratory ServiceJohannesburgSouth Africa
- Sydney Brenner Institute for Molecular BioscienceFaculty of Health Sciences, University of the WitwatersrandJohannesburgSouth Africa
| | - Timothy R. Rebbeck
- Dana Farber Cancer InstituteBostonMassachusettsUSA
- Harvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Alfred I. Neugut
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia UniversityNew York CityNew YorkUSA
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew York CityNew YorkUSA
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and SurgeonsColumbia UniversityNew York CityNew YorkUSA
| | - Maureen Joffe
- Division of Urology, Department of Surgery, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
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Ssemata AS, Muhumuza R, Seeley J, Lombe DC, Mwamba M, Msadabwe S, Mwaka AD, Aggarwal A. Moving forward through consensus: a national Delphi approach to determine the top research priorities in prostate cancer in Uganda. BMJ Open 2023; 13:e075739. [PMID: 38035740 PMCID: PMC10689405 DOI: 10.1136/bmjopen-2023-075739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE To identify key areas for research in prostate cancer (PC) in the Ugandan context by establishing the major health system, socioeconomic and clinical barriers to seeking, reaching and receiving high-quality cancer care. DESIGN Modified Delphi Technique. SETTING Government and private-not-for-profit hospitals. METHODS We applied a two-stage modified Delphi technique to identify the consensus view across cancer experts. In round 1, experts received a questionnaire containing 21 statements drawn from a systematic review identifying the reason for the delay in accessing cancer care. Each statement was scored out of 20. Statements scoring ≥15 from over 70% of participants were prioritised for inclusion while statements for which <30% of participants gave a score of ≥15 were excluded. Sixteen statements were included in round 2 as they did not receive consensus for inclusion or exclusion. RESULTS We found that the top six research priority areas arise from challenges including: (1) lack of diagnostic services-ultrasound, laboratory tests and biopsy facilities; (2) high costs of services, for example, surgery, radiotherapy, hormone therapy are unaffordable to most patients, (3) lack of essential medicines, (4) limited radiotherapy capacity, (5) lack of awareness of cancer as a disease and low recognition of symptoms, (6) low healthcare literacy. The lack of critical surgical supplies, high diagnostic and treatment costs were ranked highest in order of importance in round 1. Round 2 also revealed lack of diagnostic services, unavailability of critical medicines, lack of radiotherapy options, high costs of treatments and lack of critical surgical supplies as the top priorities. CONCLUSION These research priority areas ought to be addressed in future research to improve prompt PC diagnosis and care in Uganda. There is need to improve the supply of high-quality affordable anticancer medicines for PC patients so as to improve the survivorship from the cancer.
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Affiliation(s)
- Andrew Sentoogo Ssemata
- Social Aspects of Health Across the Lifecourse, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Muhumuza
- Social Aspects of Health Across the Lifecourse, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
| | - Janet Seeley
- Social Aspects of Health Across the Lifecourse, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Amos Deogratius Mwaka
- Department of Internal Medicine, Mulago Hospital/Makerere University, Kampala, Uganda
- Department of Medicine, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Ajay Aggarwal
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK
- King's College London, London, UK
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Nawi AM, Masdor NA, Othman R, Kandayah T, Ahmad N, Safian N. Survival Rate and Prognostic Factors of Localised Prostate Cancer in Southeast Asian Countries: A Systematic Review with Meta-Analysis. Asian Pac J Cancer Prev 2023; 24:2941-2095. [PMID: 37774044 PMCID: PMC10762736 DOI: 10.31557/apjcp.2023.24.9.2941] [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: 03/08/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023] Open
Abstract
Prostate cancer (Pca) is one of the most prevalent health conditions affecting men, particularly older men, and cases have increased in recent years. OBJECTIVE This review examined the survival rate and prognostic factors of patients with Pca in Southeast Asia (SEA). METHODS We conducted a systematic search of three databases (PubMed, Scopus, Web of Science) and a manual search until April 1, 2022. The selected papers were evaluated using the Newcastle-Ottawa Quality Assessment Form for Cohort Studies. The review protocol was registered with PROSPERO (CRD42022326521). Pooled prevalence rates were calculated using the programme R version 4.2.1. Heterogeneity was assessed using the I2 statistic and p-value. A narrative approach was used to describe prognostic factors. Studies were selected and finalised based on the review question. The quality of the included studies was assessed. RESULTS A total of 11 studies were included in this review. The 1-, 3-, 5- and 10-year survival rates of SEA Pca cases were 80.8%, 51.9%, 66.1% (range 32.1-100) and 78% (range 55.9-100), respectively. Prognostic factors for Pca were discussed in terms of sociodemographic, disease-related and treatment-related aspects. The predictors of significantly lower survival were age more than 75 years, cancer detected during transurethral resection of the prostate, Gleason score more or equal to eight, high-risk group, metastases and no adjuvant radiotherapy. A meta-analysis on the pooled HR of prostate cancer could not be performed due to the heterogeneity of prognostic factors. The pooled prevalence of localised and metastatic prostate cancer in SEA countries was 39% 95% CI [20-62] and 40% 95% CI [28-53], respectively. CONCLUSION The survival rate in SEA countries can be determined by prognostic factors, which can be divided into sociodemographic, disease-related and treatment-related factors. Therefore, further studies are needed to improve the understanding and treatment of Pca in the region SEA.
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Affiliation(s)
- Azmawati Mohammed Nawi
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia.
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Abdelrazek AS, Ghoniem K, Ahmed ME, Joshi V, Mahmoud AM, Saeed N, Khater N, Elsharkawy MS, Gamal A, Kwon E, Kendi AT. Prostate Cancer: Advances in Genetic Testing and Clinical Implications. URO 2023. [DOI: 10.3390/uro3020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The demand for genetic testing (GT) for prostate cancer (PCa) is expanding, but there is limited knowledge about the genetic counseling (GC) needs of men. A strong-to-moderate inherited genetic predisposition causes approximately 5–20% of prostate cancer (PCa). In men with prostate cancer, germline testing may benefit the patient by informing treatment options, and if a mutation is noticed, it may also guide screening for other cancers and have family implications for cascade genetic testing (testing of close relatives for the same germline mutation). Relatives with the same germline mutations may be eligible for early cancer detection strategies and preventive measures. Cascade family testing can be favorable for family members, but it is currently unutilized, and strategies to overcome obstacles like knowledge deficiency, family communication, lack of access to genetic services, and testing expenses are needed. In this review, we will look at the genetic factors that have been linked to prostate cancer, as well as the role of genetic counseling and testing in the early detection of advanced prostate cancer.
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Degu A, Mekonnen AN, Njogu PM. A Systematic Review of the Treatment Outcomes among Prostate Cancer Patients in Africa. Cancer Invest 2022; 40:722-732. [PMID: 35712853 DOI: 10.1080/07357907.2022.2091777] [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: 11/12/2022]
Abstract
Prostate cancer (PCa) is associated with a significant public health burden in Africa. This systematic review aimed to assess treatment outcomes among PCa patients in Africa. A systematic search of the literature was conducted from 1 December 2021 to 31 March 2022 to identify relevant published studies. PubMed, EMBASE, CINAHL, and Google Scholar databases were used. Twenty-four studies met the inclusion criteria, and the mean age was 68 years. Localized and locally advanced diseases had relatively higher overall survival than metastatic diseases. In metastatic disease, the mean overall five-year survival was 42% which is shorter than the Asian population (61.9%).
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Affiliation(s)
- Amsalu Degu
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy and Health Sciences, United States International University-Africa, Nairobi, Kenya
| | | | - Peter Mbugua Njogu
- Department of Pharmacy, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
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Mbey PM, Mukuku O, Arung WK, Tengu GK, Amisi NL, Kyabu VK, Odimba EFK, Tshilombo FK. Clinical, Histopathological, and Prognostic Characteristics of Patients with Prostate Cancer in Lubumbashi, Democratic Republic of Congo. Prostate Cancer 2020; 2020:5286929. [PMID: 33376609 PMCID: PMC7746450 DOI: 10.1155/2020/5286929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/03/2020] [Accepted: 12/04/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Prostate cancer is currently a public health problem with a frequency that varies from country to country. This study aims to describe the epidemiological, clinical, and histopathological and outcome features of prostate cancer in Lubumbashi in the Democratic Republic of Congo. MATERIALS AND METHODS This was a descriptive longitudinal study of patients diagnosed with prostate cancer at the University Clinics of Lubumbashi. The study period was 3 years (2017 to 2019). Parameters studied were age and clinical, biological (PSA level, prostatic specific antigen), histopathological, and outcome features. RESULTS The mean age of patients was 68.7 years (range: 47 and 90 years). The 60 to 69 age group was the most affected (43.18%). Elderly subjects (≥60 years old) represented 89.77% of the cases (n = 79). Voiding disorders were the main reason for consultation in 55.68% of the cases. The mean PSA level was 133.7 ng/ml (range: 4 and 1564.5 ng/ml) at diagnosis and 125.4 ng/ml after 3 months of follow-up (range: 0.16 and 1782.1 ng/ml). Adenocarcinoma was the predominant histological type (100%). In prognosis, 31.82% of patients had a Gleason score greater than 7 and 59.10% had a high risk at the D'Amico risk classification for Prostate Cancer. Hormone therapy was administered alone in 75% of the cases and in combination with pulpectomy in 13.64% of the cases. The 3-year overall survival was 56.82%. CONCLUSION Prostate cancer is frequent and has a poor outcome in our country. The establishment of an individual screening policy would be an undeniable advantage in improving the prognosis.
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Affiliation(s)
- Pitchou Mukaz Mbey
- Department of Surgery, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Olivier Mukuku
- Institut Supérieur des Techniques Médicales, Lubumbashi, Democratic Republic of the Congo
| | - Willy Kalau Arung
- Department of Surgery, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | | | - Nasser Lubosha Amisi
- Hôpital Militaire de Garnison de Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Véronique Kabila Kyabu
- Department of Histopathology, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Etienne Fwamba Koshe Odimba
- Department of Surgery, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - François Katombe Tshilombo
- Department of Surgery, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
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Amsi PT, Yahaya JJ, Kalungi S, Odida M. Immunohistochemical expression of BRCA1 and BRCA2 in a cohort of Ugandan men with prostate cancer: an analytical cross-sectional study. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00079-w] [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
Mutation of the tumour suppressor genes BRCA1 and BRCA2 is thought to cause early development of prostate cancer which has poor prognosis. The purpose of this study was to determine the expression of BRCA1/2 and correlate it with clinicopathological factors for patients with prostate cancer in uganda.
Methods
Retrospectively, we used immunohistochemistry to evaluate the expression of BRCA1/2 antibodies in tissue blocks of 188 patients with prostate cancer who were diagnosed between January 2005 and December 2014 in the Department of Pathology, Makerere College of Health Sciences. The Chi-Square test was used to determine the association of the categorical variables, whereas t-test was used to compare groups of mean of the variables in the study.
Results
Expression of BRCA1 and BRCA2 was found in 26.1% and 22.9% cases, respectively. Co-expression of BRCA1 and BRCA2 was found in only 7.4%. Gleason score was associated with expression of BRCA1 and BRCA2 (P = 0.013, P = 0.041, respectively). Age was not associated with BRCA1 and BRCA2 expression; P = 0.543, P = 0.091, respectively. Likewise, PSA was not associated with BRCA1 and BRCA2 expression; P = 0.446, P = 0.399, respectively.
Conclusion
BRCA1 and BRCA2 proteins in this study were expressed more in cases with poorly differentiated prostate cancer than in cases with either well or moderately differentiated prostate cancer. Co-expression of BRCA1 and BRCA2 proteins in the same patient in our study was 3 times less than either BRCA1 or BRCA2 alone.
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