Clinical Characteristics of PCa Patients in West and South Africa in the MADCAP Consortium
Mohamed Jalloh, Denzel Zhu, Ilir Agalliu, Caroline Andrews, Evan Kovac, Ben Adusei, Nana Yaa F. Snyper, James E. Mensah, Victoria Okyne, Ann W. Hsing, Akindele O. Adebiyi, Olufemi J. Ogunbiyi, Olayiwola B. Shittu, O. P. Oluwole, Maxwell M. Nwegbu, Oseremen I. Aisuodionoe-Shadrach, Pedro Fernandez, Hayley Irusen, Audrey Pentz, Maureen Joffe, Elvira Singh, Judith S. Jacobson, Alfred I. Neugut, Thomas Rohan, Lamine Niang, Serigne Gueye, Timothy R. Rebbeck
Introduction and Objective
Men of African descent have the highest burden of aggressive prostate cancer (PCa). In Sub-Saharan Africa (SSA), PCa accounts for 19% of all cancer related death. However, the clinical features of PCa within SSA are understudied.
The objective of this study was to characterize the clinical features of men with PCa in SSA, and to compare demographic and clinical features of PCa between West (WA) and South Africa (SA).
Materials and Methods
Between 2016 and 2020, we recruited 2,588 PCa patients into a multi-center, hospital-based study in Senegal, Ghana, Nigeria and South Africa via the MADCAP Consortium. Participants completed an epidemiologic questionnaire which collected information on demographics, lifestyle, PCa family history, and lower urinary symptoms (LUTS) assessed through the International Prostatic Symptom Score (IPSS); PCa clinical features were extracted through review of medical charts.
We used Student t-test, Wilcoxon sign-rank test or chi-square tests to compare patients’ characteristics by region. Multivariate logistic regression (adjusted for all variables listed) was used to measure odds of High risk PCa vs Intermediate or Low risk PCa (pooled).
•Among 2588 men with PCa, 1325 (51.2%) were recruited in WA and 1263 (49.8%) in SA.
•The majority (78.9%) of patients had high D’Amico risk PCa.
•PCa patients in WA were older at diagnosis (68.3±8.0 years) compared to SA patients (66.5±8.0, p<0.001).
•Median PSA at diagnosis was higher in WA cases (93.9, IQR: 26.5-450.9) compared to SA cases (28.5, IQR: 12.8-100.9, p<0.001).
•PCa cases in WA also had a higher prevalence of moderate and severe LUTS (63.7%) compared to PCa cases in SA (49.4%).
•Clinically invasive disease (stage T3+) was more prevalent in WA compared to SA (64.5% vs. 20.2%, p<0.001). However, the distribution of aggressive Gleason Group 4-5 PCa was similar between WA (39.9%) and SA (38.1%).
•The majority of patients were treated with hormone-therapy in both WA (42.2%) and SA (61.8%). However, in SA, a large proportion of patients are treated with radiation therapy (27.6%), while this treatment was rarely used in WA.
•Several factors were associated with high risk PCa (Table 2), including age, BMI, smoking, IPSS score, and a first-degree relative with PCa
Men in Africa present with very high-risk PCa. Patients in WA had characteristics of more advanced disease at presentation than their SA counterparts, indicated by a higher PSA, prevalence of adverse clinical features, and a greater proportion of prostatic symptoms. This data further emphasizes the need for the development of PCa screening guidelines within SSA.
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