MANAGEMENT OF PROSTATE CANCER IN ACCRA, GHANA

*Yeboah ED1 , Hsing AW2,4, Mante S3, Mensah JE1, Kyei MY1, Yarney J1, Vanderpuye V1, Beecham K1, Tettey Y1, Biritwum RB1, Adjei AA1, Gyasi R1, Asante K1, Ampadu KN1, Klufio GO1, Gepi-Attee S1, Owoo C1, Kwami D1, Ahiaku5, Pandra R6, Cook MB2,       

1University of Ghana Medical School(UGMS), Korle Bu Teaching Hospital(KBTH), Accra, Ghana now University of Ghana School of Medicine and Dentistry(UGSMD), Accra, Ghana. Email: kofiyebuk@gmail.com

2Division of Cancer Epidemiology and Genetics, National Cancer Institute(NCI),National Institute of Health(NIH), Bethesda, Maryland, USA. 337 Military Hospital, Accra, Ghana 4Stanford University – Stanford Cancer Institute, CA, USA. 5Visiting Surgeon from UK 6Visiting Surgeon, Indian Forces Hospital.

No conflict of interest.

SOURCES OF GRANT: The Ghana Study was part of Ghana Prostate Health Study (GPHS) and Case Expansion Studies 2002 – 2013 supported by National Cancer Institute/National Institute of Health (NCI/NIH) Bethesda, the University of Ghana School of Medicine and Dentistry, the Korle Bu Teaching Hospital and Government of Ghana through the Ministry of Health (MOH) Ghana.

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ABSTRACT

Introduction: Africans living with prostate cancer in Africa face problems of early diagnosis and appropriate treatment.

Aim: To study the clinical incidence of prostate cancer, risk factors, TNM stage, their management and outcomes.

Methods: A prospective study of Prostate Cancer cases managed at Korle Bu Teaching Hospital and hospitals in Accra, diagnosed by history, abnormal PSA/DRE, physical examination and histologically confirmed by biopsy from 2004 to 2013 was carried out. The cases were TNM staged and managed by approved protocol.

Results: There were 669 cases with a mean age 70±0.045SE years, median Gleason Score of 7, organ confined Prostate Cancer(PC) in 415(62%), locally advanced in 167(25%) and metastatic Prostate Cancer in 87(13%) cases. The cases were followed for median of 10 months to = 84 months. Organ confined cases were managed by: Radical Prostatectomy (RP) 92 (13.8%) with a mortality of 0.3%; brachytherapy 70 (10.5%) with a mortality of 0.1% and External Beam Radiotherapy (EBRT) 155 (23%) with a mortality 0.7%. In all, 98 men constituting (14.1%) cases with a mean age of 75+0.25SE years, life expectancy <10 years were treated by hormonal therapy with a mortality of 1.7%. Twenty cases who were for active surveillance (GS6), PSA <10ng/ml, life expectancy <10 years later all opted for EBRT. Locally advanced cases 25% all had neoadjuvant hormonal therapy then Brachytherapy in 3 (0.4%) mortality 0.15% and EBRT in 64 (9.5%), mortality 0.59%. Hormonal therapy was given in 100 (15%) locally advanced cases, mortality 5%. Metastatic prostate cancer cases (13%) were managed by hormonal therapy, mortality 6%.

Conclusions: Improved facilities and dedicated skilled teams led to a significant rise in proportion of organ confined Prostate Cancer from 15.3% to 62% curable by Radical Prostatectomy, brachytherapy or EBRT with longer disease free survival.

Key words: Prostate cancer, Gleason score, Stage, Management, Radical prostatectomy, Radiation therapy, Hormonal therapy.

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