Impact of health system challenges on prostate cancer control: health care experiences in Nigeria

Barriers and facilitators of the application of precision medicine to the genitourinary cancer care pathway: Perspective from a low- and middle- income country in sub-Saharan Africa

The benefit of the delivery of the right form of cancer care, tailored to the right patient, at the right time is increasingly being recognized in the global oncology community. Information on the role and feasible potential of precision oncology during the management of genitourinary cancer in Nigeria, the most populous country in Africa, is limited. This article, therefore, describes the present application of personalized medicine in Nigeria and its barriers and facilitators. It provided granular details on manpower distribution and epidemiological disparities. It also explored the use of clinical and biological markers for screening and early diagnosis, the application of team science to support genomic profiling, cost-effective approaches for image-based phenotypic precision oncology, the emerging role of molecular imaging, access to clinical trials; and their potential to support data driven diagnosis, treatment decision and care availability in order to address gaps in genitourinary cancer management in the country.

Prostate Cancer and Challenges in Management in a Semi-urban Centre: A 10-year Experience

INTRODUCTION

Prostate cancer (CaP) is the second most common cancer in men and the fifth most common cancer worldwide. The incidence in Nigeria is rising. Numerous challenges exist that prevent the successful management of these patients in this subregion.

AIMS AND OBJECTIVES

This study aimed to report on the modes of presentation and difficulties encountered in managing patients with CaP in our environment with a view to finding solutions to these challenges.

MATERIALS AND METHODS

This was a retrospective study of all CaP patients who were managed in Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria over a 10-year period from 2012 to 2021. Data were collated using a pro forma. Numerical data were summarized as means, median, and standard deviation, whereas categorical data were summarized as frequencies. Statistical significance was pegged at P < 0.05.

RESULTS

Seventy-three patients were analysed. The mean age of the patients was 71.48 ± 8.15 years. The three most common presenting complaints were lower urinary tract symptoms (LUTSs) 23 (31.5%), acute urinary retention 9 (12.3%), and LUTS with low back pain 9 (12.3%). The median duration of symptoms was 6.5 months. No difference was noted among educational level, occupation, and stage of CaP, (P=0.222 and P=0.548), respectively. The median total prostate-specific antigen was 85.0 ng/mL. Sixty-seven patients (91.8%) had an abdominopelvic ultrasound scan. Fifty patients (68.5%) had stage 4 disease. Thirty-eight (52.1%) had financial constraints. Forty-nine (67.1%) patients were lost to follow-up. Bilateral orchidectomy was offered to 28 (38.4%) patients.

CONCLUSION

Financial constraint was a huge barrier in the management of CaP patients in this study. Late presentation was common in this study.

Prostate cancer characteristics: A descriptive analysis of clinical features at presentation in the last decade in a black African community

Background:

Prostate cancer, previously reported as relatively rare in Nigeria, is currently the leading cancer and leading cause of cancer-related death in men. Late presentation appears to persist despite higher incidence rates and instituted awareness programs. This study assesses current prostate cancer indices at presentation to a 3^rd tier referral hospital in South-east Nigeria and compares these indices with reported indices from previous decades.

Materials and Methods:

Retrospectively, the medical records of men presenting with histologically confirmed prostate cancer from January 2009 to April 2018 were reviewed. Age, spectrum and duration of clinical features, serum total prostate-specific antigen (tPSA), and prostate biopsy specimen Gleason Score (GS) at presentation were retrieved for the analysis using the SPSS software version 21. Obtained mean values and proportions were compared to reports from previous decades for observable shifts.

Results:

The medical records of 331 men 51–90 years of age (mean: 69.8 ± 8.0 years) were retrieved. Six (1.8%) men (median tPSA = 28.0 ng/ml; range 10.0–121.4 ng/ml) had screening-detected prostate cancer. About 72.0%, 52.0%, and 30.3% of men present with symptoms after 3 months, 6 months, and 12 months, respectively, and about 55.1% had other clinical features of disease progression beyond lower urinary tract symptoms. Symptom duration, serum tPSA (median 31.4 ng/ml; range 4.0–710.0 ng/ml), and % fPSA (median 20.6%; range 57.1%–8.6%) at presentation, as well as prevalent poorly-differentiated tumor (GS ≥7 [4 + 3] 62.2%) are yet to shift from reports from previous decades.

Conclusions:

Prostate cancer indices at presentation in South-eastern Nigeria, a resource-poor community in sub-Saharan Africa are yet to positively shift despite efforts at prostate cancer awareness.

Comparison of health access, lifestyle, prostate cancer knowledge and screening among black men residing in West Africa and the USA

Background

In Blacks, late presentation, lack of knowledge, health infrastructural deficiencies and socio-demographic characteristics, which result in poor outcomes, are the bane of cancers. This study evaluated health access and lifestyle association with prostate cancer (PCa) knowledge and screening among black men.

Methodology

This study used data from the Prostate Cancer Transatlantic Consortium familial cohort study. Data were gathered from a cross-sectional survey of 500 community-dwelling black men in Nigeria, Cameroon, and the USA. Information on socio-demographics, health care access, PCa knowledge score and screening behaviour was obtained, and the association between these variables was evaluated.

Results

The majority (81.6%) were Nigerian. The age ranges were 35–49 (55.2%) and ≥65 (8.4%). The income distribution of the respondents showed that 23.3% earned <$1,000 and 30.7% (>$2,000) monthly. Only 43% had health insurance coverage, and 12% had accessed a doctor in 12 months. Respondents relied on orthodox medicine (50.8%), neighbourhood pharmacy (10.6%), self-medication (5%) and neighbourhood nurse (24.6%). The participants had either poor (45.2%) or very poor (23.2%) dietary patterns. Most (66.67%) do not engage in physical activity and about 33.33% engage in some exercises. Moreover, 87.8% and 78.3% have never had a digital rectal examination (DRE) and prostate-specific antigen (PSA) screening in their lifetime, respectively, while 6.8% and 1.6% had DRE last 1 year and 2 years, respectively. Furthermore, 65.2%, 19.8% and 15% of the respondents had poor, fair and good knowledge of PCa, respectively. Health care coverage (p < 0.001), medical care habit (p = 0.001), routine checkup (p = 0.013) were significantly associated with respondents’ PCa knowledge. Routine checkup (p < 0.001) and country (p < 0.001) were significantly related to PSA screening.

Conclusion

The study showed that PCa screening uptake was poor among the respondents and country of residence was associated with PCa screening behaviours. Healthcare coverage was significantly associated with PCa knowledge.

Improving outcomes in cancer diagnosis, prevention and control: barriers, facilitators and the need for health literacy in Ibadan Nigeria

BACKGROUND

Cancers constitute a significant public health problem in Nigeria. Breast, cervix and prostate cancers are leading causes of cancer-related deaths. Changing diets, lifestyles, HIV/AIDS and macro-structural factors contribute to cancer morbidity and mortality. Poor health information linking cancer risk to individual behaviors, environmental pollutants and structural barriers undermine prevention/control efforts. Studies suggest increasing health literacy and empowering individuals to take preventive action will improve outcomes and mitigate impact on a weak health system.

METHODS

We obtained qualitative data from 80 men, women, and young adults in 11 focus groups to assess beliefs, risk-perceptions, preventive behaviors and perceptions of barriers and facilitators to cancer control in Ibadan, Nigeria and conducted thematic analysis.

RESULTS

Participants demonstrated awareness of cancers and mentioned several risk factors related to individual behaviors and the environment. Nonetheless, myths and misconceptions as well as micro, meso and macro level barriers impede prevention and control efforts.

CONCLUSION

Developing and implementing comprehensive context-relevant health literacy interventions in community settings are urgently needed.Copyright © 2016 John Wiley & Sons, Ltd.

Prostate adenocarcinoma associated with prostatic infection due to Schistosoma haematobium. Case report and systematic review

Schistosomiasis affects more than 240 million people worldwide, an infection which may cause urogenital manifestations including, among others, squamous bladder cancer and prostate involvement. We describe the first case of a prostate adenocarcinoma associated with prostatic Schistosoma haematobium infection occurring in Angola. Prostate carcinoma was suspected because of high levels of prostate-specific antigen. This observation prompted us to review the literature on schistosomiaisis with respect to genital pathology and prostate cancer. Described genital manifestations in men include funiculitis, epididymitis, granulomata of the seminal vesicles, testicular masses, and prostate lesions which may cause haematospermia and infertility. In contrast to bladder cancer, only 12 reports including the present case on 17 cases on prostate carcinoma associated with schistosomiasis have been published worldwide. The rarity of reports on prostate carcinoma associated with schistosomiasis is partly due to diagnostic constraints, and its incidence is underestimated. However, in emerging countries, the incidence of prostate cancer appears to increase mainly as a result of urbanization and improved access to health care where schistosomiasis prevalence is decreasing.

Need for and relevance of prostate cancer screening in Nigeria

Prostate cancer (PCa) has become the most prevalent cancer among males in Nigeria, and similar to other black populations, Nigerian men present with more advanced disease at an earlier age than in several other ethnic groups. In this unscreened, high-risk group, the reference range for early detection and diagnosis as well as risk factors need to be determined through large-scale screening. Over 4 years, 1124 previously unscreened men between 40 and 85 years of age were screened at free community health programmes for PCa, using the common parameters of prostate-specific antigen (PSA) plus digital rectal examination (DRE). We thereby assessed the practicality and importance of screening. Consent was obtained, demographic data obtained, PSA measured using qualitative laboratory kits, and DRE performed by surgeons. We found that the number of men attending and consenting to screening increases from year to year. Of 40-85-year-old men, 85.4% consented, of whom 33.3% (a third) and 60% were 51-60 years old and 51-65 years, respectively. While 11.5% of men had PSA >4 ng/ml, 31.45% showed abnormal DRE. Of the men who took the PSA test, 79.2% also consented to the DRE, of whom 5.8% had combined abnormal DRE and PSA >4 ng/ml. Our findings suggest that Nigerian men are a willing group for screening by both the PSA and DRE with the positive response to calls for health screening and interest in prostate health. The finding of PSA >4 ng/ml in 11.15% of this population reveals the need for greater awareness and measures to increase early detection. However, the value and validity of established PSA reference ranges and cutoff of 'normal' still need to be established. Screening is very important to better define the PCa prevalence and characteristics in our population; otherwise political and economic circumstances will ensure that men still present late with aggressive PCa.

Orally bioavailable tubulin antagonists for paclitaxel-refractory cancer

PURPOSE

To evaluate the efficacy and oral activity of two promising indoles, (2-(1H-indol-3-yl)-1H-imidazol-4-yl)(3,4,5-trimethoxyphenyl)methanone [compound II] and (2-(1H-indol-5-ylamino)-thiazol-4-yl)(3,4,5-trimethoxyphenyl)methanone [compound IAT], in paclitaxel- and docetaxel-resistant tumor models in vitro and in vivo.

METHODS

The in vitro drug-like properties, including potency, solubility, metabolic stability, and drug-drug interactions were examined for our two active compounds. An in vivo pharmacokinetic study and antitumor efficacy study were also completed to compare their efficacy with docetaxel.

RESULTS

Both compounds bound to the colchicine-binding site on tubulin, and inhibited tubulin polymerization, resulting in highly potent cytotoxic activity in vitro. While the potency of paclitaxel and docetaxel was compromised in a multidrug-resistant cell line that overexpresses P-glycoprotein, the potency of compounds II and IAT was maintained. Both compounds had favorable drug-like properties, and acceptable oral bioavailability (21-50 %) in mice, rats, and dogs. Tumor growth inhibition of greater than 100 % was achieved when immunodeficient mice with rapidly growing paclitaxel-resistant prostate cancer cells were treated orally at doses of 3-30 mg/kg of II or IAT.

CONCLUSIONS

These studies highlight the potent and broad anticancer activity of two orally bioavailable compounds, offering significant pharmacologic advantage over existing drugs of this class for multidrug resistant or taxane-refractory cancers.