Abstract:
BACKGROUND: Although prostate cancer (PCa) is the most commonly diagnosed cancer in men of sub-Saharan Africa (SSA), little is
known about its management and survival. The objective of the current study was to describe the presentation, patterns of diagnosis,
treatment, and survival of patients with PCa in 10 countries of SSA. METHODS: In this observational registry study with data collec-
tion from 2010 to 2018, the authors drew a random sample of 738 patients with PCa who were registered in 11 population-based cancer
registries. They described proportions of patients receiving recommended care and presented survival estimates. Multivariable Cox
regression was used to calculate hazard ratios comparing the survival of patients with and without cancer-directed therapies (CDTs).
RESULTS: The study included 693 patients, and tumor characteristics and treatment information were available for 365 patients, 37.3%
of whom had metastatic disease. Only 11.2% had a complete diagnostic workup for risk stratification. Among the nonmetastatic patients,
17.5% received curative-intent therapy, and 27.5% received no CDT. Among the metastatic patients, 59.6% received androgen deprivation
therapy. The 3- and 5-year age- standardized relative survival for 491 patients with survival time information was 58.8% (95% confidence
interval [CI], 48.5%-67.7%) and 56.9% (95% CI, 39.8%-70.9%), respectively. In a multivariable analysis, survival was considerably poorer
among patients without CDT versus those with therapy. CONCLUSIONS: This study shows that a large proportion of patients with PCa
in SSA are not staged or are insufficiently staged and undertreated, and this results in unfavorable survival. These findings reemphasize
the need for improving diagnostic workup and access to care in SSA in order to mitigate the heavy burden of the disease in the region.
Cancer 2021;127:4221-4232. © 2021 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society. This
is an open access article under the terms of the Creative Commons Attribution-NonCo mmercial License, which permits use, distribution
and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.