Prostate cancer (PC)-management of 669 cases in Ghana West Africa

Abstract

Objectives: To study clinical incidence of histologically proven PC, TNM stage and management outcomes Methods: Case expansion study of PC managed in Accra, abstracted records 2004–2012. Diagnosis by history, Hogh PSA, physical and abnormal DRE and his- tologically confirmed by biopsy. With gleason scores (GS) and TNM staged and managed by approved protocols. Organ confined PC by radical prostatectomy (RP), brachytherapy (BRCHY), external beam radiotherapy (EBRT), Hormonal/Chemotherapy, or surveillance if life expectancy less than 15 years. T3-4M0 treated by hormonal/chemotherapy ± Total androgen blockade (TAB), BRCHY/EBRT. Metastatic T1-4-M1 is treated by hor- monal/chemotherapy ± TAB. Significant LUTO is treated by alpha blockers, TUIP/TURP. Results: There were 669 cases median age 70 years, median GS 7,organ confined PC 415 (62%), T3-4 M0 167 (25%), METASTATIC CASES 87 (13%). The report on 669 cases were followed for 1–7 years is as follows. A. Organ Confined T1-2 N0 M0 PC– n = 415 presentation is asymptomatic. Symptomatic cases 1–20% treatment regimes i) Radical Prostatectomy – n = 92. Open retropubic/prior median PSA 16.1 ng/ml, post PSA 0.23 ng/ml. RP specimen BPH = 3, organ con- fined 76, positive margins 13. Complications rate (COMP) 3–22%. ii) Brachytherapy – n = 70.145 GY, median prior PSA 14.6 ng/ml, post PSA 0.59 ng/ml. COMP 3–10%. iii) EBRT no = 155. 70/74GY. Median prior PSA 15.7 ng/ml post PSA 0.54 ng/ml. COMP 2–6%. iv) Hormonal Chemotherapy + TAB – n = 98 prior median PSA 48.5 ng/ml, post PSA 0.6 ng/ml. METHODS LHRH analogue /Chemotherapy 41%, stilboesterol 29%, BTO 30%. COMP 4–30%. v) Surveillance GS 6.prior PSA < 8 ng/ml. Presentation symptomatic 60%. All had neoadjuvant hormonal/chemotherapy + TAB, LHRH 52%, stilboesterol 12%, BTO36% then i) Bachytherapy – T3N3, prior PSA 14.6 ng/ml, post PSA 0.11 ng/ml. ii) EBRT. no-64. Prior PSA T3 (34%) 32.4 ng/ml, T4 (2%) 64.6 ng/ml, Post PSA T3 0.6 ng/ml, T4 0.4 ng/ml, COMP = 2–70%. iii) Hormonal chemotherapyn = 103 (T3 24%, T4 38%), LHRH 28% stilboesterol 4%, BTO 30%, COMP 4–35%, Hospitalmortality 26.3%.

Advanced Metastatic T1-4 N1-3 M1 n = 87, 13% median prior PSA 93 ng/ml, post PSA 0.4 ng/ml. Presentation all symptomatic .RX LHRH 23%, Stilboesterol 17%, BTO 60%, COMP 20–34%, Hospital mortality 37%. Conclusions: Prior to 2000 15.3% organ confined, T3/T4 32% and metastatic 52%. Improved facilities and skilled teams since 2004 led to organ confined PC 62% curable by RP, brachytherapy or EBRT with longer disease free survival but advanced disease pose challenges for disease control.

http://dx.doi.org/10.1016/j.afju.2014.03.011