Clinicopathological Features and Management of Prostate Cancer at the University of Uyo Teaching Hospital, Nigeria
TL;DR
Patients with prostate cancer presented at a late stage, with locally advanced and metastatic disease, most patients had moderately or poorly differentiated adenocarcinoma and androgen deprivation therapy was the treatment modality for most patients.
Abstract
Aim: This study aimed to determine the clinicopathological features, comorbidities, management outcomes and hospital prevalence of prostate cancer (PCa) in a Nigerian teaching hospital. Study Design: This was a retrospective study of 210 patients diagnosed with prostate cancer. Place and Duration of Study: The study was conducted at the University of Uyo Teaching Hospital in Nigeria over a 10-year period, from 2013 to 2022. Methodology: Men aged 45-90 years with histologically diagnosed prostate cancer were included in the study. Data retrieved from patients' case files, ward/clinic records and operation registers included age, clinical features, investigation results, prostate-specific antigen, histological type, Gleason scores and treatment modalities. Clinicopathological characteristics and treatment outcomes were analysed. Hospital prevalence was calculated by dividing the number of PCa cases by the total number of adult male patients seen during the study period and was estimated per 100,000. Results: There were 139,072 males aged 40 years and above treated in the hospital during the study period, of whom 210 had a histological diagnosis of prostate cancer, giving a hospital prevalence of 151/100,000. The mean age was 64.66 ± 9.24 SD (range: 45-90 years), and the median age was 65 years. The mean initial PSA was 46.98 ± 34.15 SD. Most patients (96%) had adenocarcinoma, 2% had urothelial carcinoma and 2% had squamous cell carcinoma. Gleason scores of 5-7 were seen in 105 patients (50.0%) and scores of 8-10 in 91 patients (43.3%), while 14 patients (6.7%) had scores of 2-4. Advanced prostate cancer (TNM group stages III and IV) was present in 85.2% of patients, while 14.8% had group stages I and II disease. One hundred and ninety-one patients (90.9%) had androgen deprivation therapy with bilateral orchidectomy, luteinising hormone-releasing agonists, antiandrogens and oestrogens. Only ten patients (4.8%) with early localised lesions had radical retropubic prostatectomy or radical radiotherapy, while nine patients (4.3%) had no treatment. Approximately 70% of patients died within 5 years of diagnosis. The remaining patients were lost to follow-up. Conclusion: Patients with prostate cancer presented at a late stage, with locally advanced and metastatic disease. Most patients had moderately or poorly differentiated adenocarcinoma. Androgen deprivation therapy was the treatment modality for most patients. Prostate cancer screening and early detection are strongly advocated so that definitive therapy for localised lesions may reduce mortality.