Prostate cancer in the West African sub-region, the need to know

It is trite to state that prostate cancer has become an epidemic among African Americans. For a while, the disease was erroneously ascribed a rare prevalence in Nigerians, until the seminal study of Prof Dom Osegbe3. The study of prostate cancer in the world has moved from epidemiological searches to aetiological factors and best treatment issues. The aetiology of prostate cancer remains an enigma, beyond the facts that race, environment and genetics have contributory roles in its occurrence. The treatment of prostate cancer has not fared better in the hands and minds of urologists and oncologists. Compounding the problem is lack of knowledge of the natural history of the affliction4. The discovery of prostate specific antigen (PSA) as a replacement for the role of serum acid phosphatase was anticipated to aid the diagnosis of the disease. In spite of the initial enthusiasm for PSA, it has now dawned on urologists that PSA is a mere marker whose major role is to guide clinicians as to what next to do. It is not a diagnostic tool. False positive5 and false negative6 results have been reported from PSA readings when matched with clinico-pathological findings. Frustrated by these circumstances, attention has moved on to quality of life issues regarding prostate cancer.

Unfortunately, in the West African sub-region, the study of the epidemiology of prostate cancer remains a wish rather than an accomplished quest. There has been no population based study to discover the incidence of prostate cancer in West Africa7. This is in spite of numerous publications on the experience in individual centres which are mainly from hospital-based retrospective reports. At a few meetings of Pan African Urological Surgeons’ Association (PAUSA) and Nigerian Association of Urological Surgeons (NAUS), the need to undertake population-based studies of the disease in the sub-region has been articulated. A few study groups have been set up. So far, no reports have been made known to the interested audience. Several reasons may account for this. As soon as the groups return to their bases spread over many geo-political entities, the immediate problems of finance and communication emerge to frustrate any genuine intent. Commitment from expected sponsors, government and the industry, is lacking. To mount a population based study is not an enterprise for the enthusiastic researcher without appropriate and adequate sponsorship.

Furthermore, there is a lot of inertia to scientific health study projects in the sub-region. The establishment of a conscientious cancer registry has been rather too tardy. Two environmental subgroups can be identified in the West African sub-region for comparative epidemiological study, the savannah (Sahel) region and the rain forest (Delta) region. Information garnered from such a study will augment to suspected contribution of environment in the aetiology of the disease.

Treatment of prostate cancer is beset by a myriad of problems including general public unawareness, lack of screening, material poverty and global ignorance. The ultimate expression of these factors is late presentation of clients for medical attention. Often, the primary health officials they encounter are handicapped by some of the very same factors confronting the clients, such as inadequate knowledge of the disease condition and dearth of clinical facilities for diagnosis, staging and treatment. Increasing numbers of patients are now able to present early and afford treatment, both locally and through medical tourism to India, Europe and the North American states of Canada and United States of America. However, this number is a far cry from the enormous disease burden.

In order to better allot resources when the socio-political will prevails in the sub region, it is prudent to ascertain the burden of prostate cancer by a scientifically conducted population-based epidemiological study of the ailment. The West African College of Surgeons ought to address this problem both on its own and with the collaboration of national and regional urological associations in its constituency.

References

• Hsing AW, Tsao L, Devesa SS. International trends and patterns of prostate cancer incidence and mortality. Int J Cancer 2000; 85:60-67.
• Pienta KJ, Demers R, Hoff M, Kau TY, Montie JE, Severson RK. Effect of age and race on survival of men with prostate cancer in the metropolitan Detroit tricounty area 1973 to 1987. Urology 1995; 45:93-101
• Osegbe DN. Prostate cancer in Nigerians: facts and nonfacts. J Urol 1997; 157:1340-1343.
• Eke N, Essiet A. Prostate cancer, so much verbiage so modest mileage. Journal of the West African College of Surgeons 2011; 1:3-30.
• Bozeman CB, Carver BS, Eastham JA, Venable DD. Treatment of chronic prostatitis lowers serum prostate specific antigen. J Urol 2002; 167:1723-1726.
• Gann PH, Hennekens CH, Stampfer MJ. A prospective evaluation of plasma prostate-specific antigen for detection of prostatic cancer. JAMA 1995; 273:289-294.
• Chu LW, Ritchey J, Devesa SS, Quraishi SM, Zhang H, Hsing AW. Prostate cancer incidence rates in Africa. Prostate Cancer. 2011;2011:947870. Epub 2011 Aug.

Professor Ndubuisi Eke FWACS.
Urology Division, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. E-mail:ndueke2004@yahoo.com

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