CLINICO-DEMOGRAPHIC PROFILE AND TREATMENT OF PATIENTS WITH PROSTATE CANCER IN A NORTH- CENTRAL NIGERIAN TEACHING HOSPITAL

J.O Akhaine1, S.I Shuaibu2, O.I Osunaiye3, C.G Ofoha2

  1. Department of Surgery, Federal Medical Centre, Keffi, Nigeria.
  2. Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria.
  3. Department of Surgery, Federal Medical Centre, Lokoja, Nigeria.

Abstract

Background: Prostate cancer is one of the most common malignancies afflicting men worldwide. In the male population, it is estimated that one in seven will be diagnosed and one in 38 will die from prostate cancer. Majority of patients in Sub Saharan Africa present with advanced disease.

Objective: To identify among prostate cancer patients, the age, clinical manifestation and stage at presentation as well as treatment received. Materials and Method: The study reviewed patients with prostate cancer at the Jos University Teaching Hospital between January 2014 and December 2017. The demographic and clinical characteristics as well as treatment given were analysed.

Results: A total of 82 patients were studied. Age range was 41-100 years with a median of 67.9 years. The peak age group was 71-80 years, accounting for 41.4% of patients. Lower urinary tract symptom was present in all patients at the time of presentation. 59.8% of these patients presented with metastatic symptoms. Persistent low back pain was seen in 61.2 % of patients with metastatic symptoms, and digital rectal examination was suggestive of malignancy in 62.2% of patients. PSA was >20ng/ml in 73.3% of patients. Histology for all patients was adenocarcinoma, with a predominant Gleason score of 8 (29.3%). Bilateral total orchidectomy was offered in 59.8% of patients.

Conclusion: Majority of patients with carcinoma of the prostate in Jos have features of metastasis at the time of diagnosis. Orchidectomy is the most common treatment offered in our environment.

Keywords: Clinico-demographic profile, Prostate cancer, Treatment

Correspondence:

Dr. J.O. Akhaine
Department of Surgery,
Federal Medical Centre,
Keffi, Nasarawa State,
Nigeria.
E-mail: jaoft182000@gmail.com
Submission Date: 12th Feb., 2023
Date of Acceptance: 30th Oct., 2023
Publication Date: 1st Nov., 2023

Introduction

The first documented report of prostate cancer dates back to 1853 when J. Adams, a surgeon at The London Hospital, described the first case, which he discovered by histological examination. Adams noted in his report that this condition was “a very rare disease”.1 Remarkably, more than 150 years later, prostate cancer is a leading cancer diagnosis and cause of cancer-related deaths among men and a significant health problem.2 Today, prostate cancer has become the second most commonly diagnosed cancer and fifth most common cause of cancer death among men, and represents a substantial health burden.3,4 In the male population, it is estimated that one in seven (15.3%) will be diagnosed and one in thirty-eight (2.6%) will die from prostate cancer. Prostate cancer varies by race and ethnicity, with African Americans having 59% higher incidence than whites.5 Prostate cancer mortality rates are noted to be generally highest in the predominately black populations of the Caribbean and sub-Saharan Africa.4 A study in Nigeria showed that prostate cancer accounts for 11% of male cancers with a mean age of 71.4 years.6 While there is an increase in early detection of prostate cancer in the western world, this is unfortunately not the case in Africa especially the sub-Saharan region as late presentation is the norm.7 Several factors have been known to contribute to the development of prostate cancer. Unlike most cancers which have peak age incidences, incidence of prostate cancer continues to rise with increasing age, hence age has been adjudged the strongest of the risk factors for prostate cancer development.8 Others, include black race and positive family history. Prostate cancer is known to rarely cause symptoms before it gets to an advance stage. Thus, early diagnosis requires a high index of suspicion. The presence of symptoms is often indicative of a locally advanced or metastatic disease.9 Advanced prostate cancer refers to cancers that have gone beyond the prostatic capsule or cancers with a Gleason score >7.

Tools that are recognized in prostate cancer diagnosis and screening include digital rectal examination (DRE), prostate specific antigen testing (plus its refinements like PSA density) and transrectal ultrasound scans. Prostate specific antigen (PSA) is widely used in detection of prostate cancer. PSA testing increases the positive predictive value of DRE for prostate cancer hence, the use in combination by most urologist for prostate cancer detection.10

The optimum treatment option available to patients with prostate cancer at all stages of the disease has been a subject of debate due to uncertainty surrounding the relative efficacy of various modalities including radical prostatectomy, radiotherapy, surveillance and endocrine therapy, hence treatment decisions are guided by grade and stage of tumor, life expectancy of disease, associated morbidity as well as patient and surgeons preferences.9 This study seeks to review the clinical characteristics of patients with prostate cancer and treatment given at a tertiary health institution in North central Nigeria.