Early results of prostate cancer radiation therapy at Korle Bu Teaching Hospital: An analysis with emphasis on research strategies to improve treatment delivery and outcomes among patients in Ghana.

Abstract

e15163 Background: Although there is interest in racial disparities in prostate cancer outcomes among persons of African descent living in the United States there is scant data available regarding disease presentation and treatment response among black men living in Africa. In this study we evaluate disease presentation and early clinical outcomes among Ghanaian men with prostate cancer treated with external beam radiotherapy (EBRT). Methods: A total of 379 men with prostate cancer were referred to the National Center for Radiotherapy and Nuclear Medicine, Ghana, from January 2003 to December 2009. Data were collected regarding patient- and tumor-related factors such as age, prostate specific antigen (PSA), Gleason score, clinical stage, and use of hormonal therapy. For patients who received EBRT, freedom from biochemical failure (FFbF) was evaluated using Kaplan-Meier analysis. Results: The median age at diagnosis was 65 years. Of 379 patients referred for treatment 69.6% of all patients had initial PSA >20ng/ml, and the median iPSA was 39.0 ng/ml. A total of 128 men representing 33.8% of overall cohort were diagnosed with metastatic disease at time of referral. We identified 166 men treated with EBRT or brachytherapy +/- androgen depravation therapy (ADT), and an additional 139 men treated with ADT alone (including orchiectomy in 38 patients). The median EBRT dose was 70 Gy, in 2 Gy per fraction. Among all EBRT patients with at least 2 years of follow-up after treatment (n=52; median follow-up time: 38.9 months), 5-year actuarial FFbF was 65.1%: 67.0% for patients with PSA < 30.0 ng/mL and 63.2% for PSA ≥ 30.0 ng/mL [log-rank, p=0.586]. Conclusions: This is the largest series reporting on outcomes for prostate cancer treatment in West Africa. That one-third of patients presented with metastatic disease suggests potential need for earlier detection of prostate cancer to permit curative-intent local therapy. Data from this study will aid in the strategic development of a prostate cancer research roadmap in Ghana, with a focus on improving therapeutic approach as well as fostering a prudent allocation of scarce resources.