Natural history of castration-resistant prostate cancer in sub-Saharan African black men: a single-centre study of Nigerian men.

Jibril O Bello

doi:10.3332/ecancer.2018.797

Abstract

PurposeNative sub-Saharan African black men (SSBM) are disproportionately impacted by higher stage and incurable forms of prostate cancer (PCa). This study evaluates the natural history and survival of a cohort of SSBM with castration-resistant prostate cancer (CRPC).MethodsA retrospective study of patients with CRPC as defined by the Prostate Cancer Working Group 2 managed at a centre in sub-Saharan Africa between January 2011 and December 2015 was conducted. The principal endpoint was overall survival (OS). Potential prognostic variables were evaluated using Cox proportional hazard regression models.ResultsA total of 48 patients were identified. Median (IQR) age and prostate-specific antigen (PSA) at diagnosis were 70 (64–74.5) years and 42 (8.0–123.6) ng/mL, respectively. Only 15 (31.3%) patients received docetaxel and one patient each received the novel drugs enzalutamide and abiraterone. Twenty-eight patients (58.3%) died during follow-up with a median OS of 11 (95% CI: 8–14) months. Docetaxel chemotherapy and ECOG performance status were found to be prognostic (docetaxel use: hazard ratio 0·25, 95% CI 0·10–0·67, p = 0·006; ECOG 0–2: 0·26, 0·11–0·62, p = 0·003).ConclusionThis study of SSBM with CRPC revealed a mainly unmodulated clinical course with poor access to active treatments and poor survival. Improving access to new active therapies would improve survival.

Highlights

Compared to men from other world regions, sub-Saharan African black men (SSBM) are disproportionately impacted by higher stage and incurable forms of prostate cancer (PCa) [1,2,3,4]
This study interrogated mature survival data of a cohort of native black men with castration-resistant prostate cancer (CRPC) residing in a community in Central Nigeria, western sub-Saharan Africa, to describe the natural history of the disease, evaluate overall survival (OS) and assess potential prognostic factors
Median age and prostate-specific antigen (PSA) at diagnosis of CRPC were 70 years and 42 ng/mL, respectively; a quarter of the patients were resident in rural communities

Summary

Introduction

Compared to men from other world regions, sub-Saharan African black men (SSBM) are disproportionately impacted by higher stage and incurable forms of prostate cancer (PCa) [1,2,3,4]. Some of the active therapies approved for clinical use and included in several guidelines have proven beneficial in improving symptoms, quality of life and survival [8,9,10,11] Many of these active therapies are unavailable to impacted SSBM populations due to high costs, low health insurance coverage or outright unavailability in the region. These men have not benefitted from the recent advances in CRPC care as have men in the developed world and most still receive mainly supportive care. This study interrogated mature survival data of a cohort of native black men with CRPC residing in a community in Central Nigeria, western sub-Saharan Africa, to describe the natural history of the disease, evaluate overall survival (OS) and assess potential prognostic factors

Methods

Results

Discussion

Conclusion