Prostate cancer survival in sub-Saharan Africa by age, stage at diagnosis, and human development index: a population-based registry study

Tobias P Seraphin,Eric Chokunonga,Anne Korir,Henry Wabinga,Mathewos Assefa,Freddy Gnangnon,Nontuthuzelo I M Somdyala,Walburga Y Joko-Fru,Eva J Kantelhardt,Guy N’Da,Rolf Hansen,Shyam S Manraj,Donald M Parkin,Nathan G Buziba,Biying Liu,Anne Finesse

doi:10.1007/s10552-021-01453-x

Abstract

ObjectivesTo estimate observed and relative survival of prostate cancer patients in sub-Saharan Africa (SSA) and to examine the influence of age, stage at diagnosis and the Human Development Index (HDI).Patients and methodsIn this comparative registry study, we selected a random sample of 1752 incident cases of malign prostatic neoplasm from 12 population-based cancer registries from 10 SSA countries, registered between 2005 and 2015. We analyzed the data using Kaplan-Meier and Ederer II methods to obtain outcome estimates and flexible Poisson regression modeling to calculate the excess hazards of deathResultsFor the 1406 patients included in the survival analyses, 763 deaths occurred during 3614 person-years of observation. Of patients with known stage, 45.2% had stage IV disease, 31.2% stage III and only 23.6% stage I and II. The 1 and 5-year relative survival for the entire cohort was 78.0% (75.4–80.7) and 60.0% (55.7–64.6), while varying between the registries. Late presentation was associated with increased excess hazards and a 0.1 increase in the HDI was associated with a 20% lower excess hazard of death, while for age at diagnosis no association was found.ConclusionsWe found poor survival of SSA prostatic tumor patients, as well as high proportions of late stage presentation, which are associated with inferior outcome. This calls for investment in health-care systems and action regarding projects to raise awareness among the population to achieve earlier diagnosis and improve survival.

Highlights

According to GLOBOCAN estimates for the year 2018, prostate cancer was the top cancer in terms of age-standardized incidence rates in males in the majority of countries (118) worldwide and in most of those in sub-Saharan African (SSA) (42) [1]
Shown is the number of the cases in the random sample included for survival analysis, following exclusion on non-eligible cases, as described above, their mean age and the percentage of morphologically verified (MV) cases
1406 prostate cancer patients were included in the survival analysis, representing 80% of our random sample

Summary

Introduction

According to GLOBOCAN estimates for the year 2018, prostate cancer was the top cancer in terms of age-standardized incidence rates in males in the majority of countries (118) worldwide and in most of those in sub-Saharan African (SSA) (42) [1]. It is predicted, that just through demographic changes, the annual number of incident prostate cancer cases in Africa will more than double during the 20 years [2]. Population-based cancer registries originally monitored the occurrence of incident cancers, “the activities of cancer registries have developed far beyond this to include studies of cancer cause and prevention, and to provide the information needed for the planning and evaluation of cancer-control programmes” [12]

Objectives

Methods

Results