Abstract
BackgroundThough it is well established that black men are at higher risk of prostate cancer (PCa) very little is known about the disease in native sub Saharan black men. Newly diagnosed metastatic PCa patients treated with primary androgen deprivation therapy were identified and predictors of progression-free survival (PFS) assessed.MethodsPatients diagnosed with metastatic PCa between 2010 and 2015 in a sub Saharan black population were included in the study. Primary outcome measure was PFS defined as time from primary androgen deprivation therapy to clinical progression or death. Demographic, clinical and PSA kinetic variables were evaluated for their prognostic power using Cox proportional hazard regression models.ResultsSeventy-nine patients met the eligibility criteria and were analyzed. Median age, median overall survival and PFS was 69 years, 40 months and 27 months respectively. A PSA nadir >4 ng/mL was found to predict an earlier clinical progression. Median PFS was shorter in those with PSA nadir >4 ng/mL (15 months) compared to those with PSA nadir ≤4 ng/mL (29 months); log rank p value = 0.003.ConclusionsThe PSA nadir achieved following primary androgen deprivation therapy predicts progression-free survival in sub Saharan black men newly diagnosed with metastatic PCa. PSA nadir >4 ng/mL was found to be associated with a more rapid clinical progression.
Highlights
Though it is well established that black men are at higher risk of prostate cancer (PCa) very little is known about the disease in native sub Saharan black men
overall survival (OS) is the standard endpoint in survival analysis, progression-free survival (PFS) is a relevant endpoint in the setting of metastatic PCa as patients often eventually die of disease progression. This cohort was generated from clinical records of newly diagnosed black men with metastatic PCa who presented for care at a tertiary care hospital in North Central Nigeria, West Africa between June 2010 and July 2015
Prognosticators of clinical progression found on univariate analysis (Table 2) were analgesic consumption (NSAID use) and Prostate-specific antigen (PSA) nadir
Summary
Though it is well established that black men are at higher risk of prostate cancer (PCa) very little is known about the disease in native sub Saharan black men. The exact burden of Prostate cancer (PCa) in sub Saharan Africa remains largely unknown [1]; the region is home to the largest populations of black men, a well-established high risk group for PCa. despite this, very little is known about the basic and clinical aspects of the disease in these native black men. In the few studies that are available, findings have supported the widely-held view that significantly higher proportion of men in the region present late with advanced disease compared to most other regions of the world [3] This may be attributable to a near lack of any established systematic screening practices in the region during the early PSA era when PCa screening. Wide variability in clinical progression of metastatic PCa has been observed and though certain demographic, Bello BMC Urology (2017) 17:39
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