Pattern and Presentation of Prostate Cancer at a Referral Centre in the Brong Ahafo Region of Ghana; A 10-Year Retrospective Study

Abstract

Introduction: Prostate cancer is gradually reaching a very high incidence in Africa, especially in the Sub-Saharan region. Understanding the dynamics in occurrence of the disorder is one approach to developing effective public health programmes and interventions that will help curb the rising incidence. Objective: This study was aimed at providing comprehensive and credible data on prostate cancer by assessing the incidence, trend and presentation in the Brong Ahafo Region of Ghana. We sought to provide region-specific hardcore data that will help to assess the issue and provide remedies. Methodology: All prostate disease cases recorded from the year 2009 to 2018 were retrospectively reviewed. Subjects from 40 years and above were eligible for screening. Diagnostic and screening tools for prostate cancer at the study site include family history, serum prostate specific antigen (PSA) test, digital rectal examination, urological ultrasound scan and histopathology (biopsy). Age, PSA values and year of screening/diagnosis were also retrieved from patient folders for the study. Histological findings and parameters considered in the study included diagnosis, carcinoma grading, perineural invasion (PNI) and percentage of affected tissues (%TA). Results: Prostate cancer cases were 369, representing 36.4% of the 1,014 prostate diseases studied. The highest annual incidence was recorded in 2014 with 51 cases (13.8%). The ages of patients ranged from 46 to 101 years with a modal age range of 70 - 79 years and a mean ± SD of 72.2 ± 9.8. The mean PSA value recorded was 37.1ng/ml (±107.3) with predominance in the 11 - 20.9 ng/ml range. Majority of Group Grade 2-5 (79%) constituted progressive prostate cancer. There was no significant correlation (p = 0.091) between grade of prostate cancer and perineural invasion. Conclusion: There is a high incidence of prostate cancer in the Brong Ahafo Region of Ghana (32 per 100,000), predominantly advanced prostatic carcinoma. Reported cases also show high %TA (38.7%) and PNI (38.0%). Early screening for prostate diseases should be encouraged to avoid progression to advanced stage and public health interventions are needed to address some of these issues.