Management of Advanced and Metastatic Prostate Cancer: A Need for a Sub-Saharan Guideline.

Ayun Cassell,Lamine Niang,Abdourahmane Diallo,Bashir Yunusa,Mohamed Jalloh,Mouhamadou M Mbodji,Serigne M Gueye,Issa Labou,Saint Charles Kouka,Medina Ndoye

doi:10.1155/2019/1785428

Abstract

The estimated incidence rate of prostate cancer in Africa was 22.0/100,000 in 2016. The International Agency for Research on Cancer (IARC) has cited prostate cancer as a growing health threat in Africa with approximated 28,006 deaths in 2010 and estimated 57,048 deaths in 2030. The exact incidence of advanced and metastatic prostate cancer is not known in sub-Saharan Africa. Hospital-based reports from the region have shown a rising trend with most patients presenting with advanced or metastatic disease. The management of advanced and metastatic prostate cancer is challenging. The available international guidelines may not be cost-effective for an African population. The most efficient approach in the region has been surgical castration by bilateral orchidectomy or pulpectomy. Medical androgen deprivation therapy is expensive and may not be available. Patients with metastatic castrate-resistant prostate cancer tend to be palliated due to the absence or cost of chemotherapy or second-line androgen deprivation therapy in most of Africa. A cost-effective guideline for developing nations to address the rising burden of advanced prostate cancer is warranted at this moment.

Highlights

174,650 new prostate cancer cases were estimated to be diagnosed in 2019 which is about 20% of new cancer cases in men [1]
According to the 2019 National Comprehensive Cancer Network Guidelines (NCCN), the increase in the number of metastatic prostate cancer may have been influenced by guideline recommendations which could have resulted in reduced detection of localized prostate cancer and lesser radical prostatectomies being performed [1]
Ese papers included systemic reviews and meta-analysis, randomized controlled trials, clinical guidelines, review articles, and prospective and retrospective studies. e abstracts or full texts from the sub-Saharan literature were reviewed for age, staging presentation, prostate-specific antigen (PSA), and Gleason scores (Table 1), presenting symptoms and site of metastasis (Table 2), and treatment modality and outcome (Table 3)

Summary

Introduction

174,650 new prostate cancer cases were estimated to be diagnosed in 2019 which is about 20% of new cancer cases in men [1]. In the past few years, in the United States, there has been a slight increase in metastatic prostate cancer and prostate cancer-related mortality, 26,730 deaths in 2017 to 31,620 death in 2019 [1, 2]. E International Agency for Research on Cancer (IARC) highlighted prostate cancer as a growing health threat in Africa with approximated 28,006 deaths from prostate cancer in 2010 and estimated 57,048 deaths in 2030. In sub-Saharan Africa, the Institute for Health Metrics and Evaluation (IHME) study estimated the prostate cancer death to have increase from 5,600 in 1990 to 12,300 in 2010 [3]. A systemic review and meta-analysis by Adeloye et al in 2016 showed a rise in prostate cancer incidence and mortality in Africa [4]. A systemic review and meta-analysis by Adeloye et al in 2016 showed a rise in prostate cancer incidence and mortality in Africa [4]. e estimated pooled prostate cancer incidence rate in the study was 22.0/100,000 with a 95% confidence interval of 19.93–23.97 [4]

Methods

Results

Conclusion