Incidence of skeletal-related events in advanced and metastatic prostate cancer patients treated with androgen deprivation therapy in a low- and middle-income country

Abstract

Context: Skeletal-related events (SREs) occur in men with prostate cancer (CaP) and may result from androgen deprivation therapy (ADT). Aims: The purpose of this study was to determine the incidence of SREs in patients with CaP treated with HT while highlighting the burden of advanced and metastatic CaP in a low- and middle-income country practice. Settings and Design: Eligible cases were newly diagnosed patients with CaP seen at the University of Abuja Teaching Hospital, Abuja, Nigeria between January 2012 and December 2015 with bone metastases and treated with ADT. Subjects and Methods: Data compiled from patient's medical records showed tumor diagnosis, laboratory and radiology results. SREs included spinal cord compression, surgery to bone, pathologic fracture, and radiation to bone. Statistical Analysis Used: The data were analyzed using SPSS version 20 for windows (SPSS INC: Chicago Illinois). Results: Two hundred and nineteen cases of CaP were seen over the period of which 142 (64.8%) cases were first diagnosed as American Joint Committee on Cancer Stage IV CaP and commenced on ADT. More than half the patients on ADT were older >65 years with a mean (standard deviation [SD]) of 68.3 (±9.5) years. Serum prostate-specific antigen range was 1.4–2461.58 ng/ml with a mean (SD) of 113.7 (±288.9) ng/ml. Twenty nine patients (20.5%) had one or more SREs with spinal cord compression (19.1%), pathological fractures (1.4%), and radiotherapy to the affected bone (1.4%) being the most common SREs. ADT was orchiectomy, LHRH, anti-androgens, and complete androgen blockade (orchiectomy plus antiandrogens) in 14 (9.8%), 3 (2.1%), 44 (30.9%), and 81 (57%) patients, respectively. Conclusions: Sixty-five percent of the cases in this series were either advanced or metastatic CaP at first diagnosis majority of whom went on to orchiectomy plus antiandrogens as ADT. This lends credence not only to late presentation and increased morbidity and mortality of CaP in our environment but also to significantly low penetration of radiotherapy services and access to LHRH.