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. 2016 Oct-Dec;6(4):31-65.

MANAGEMENT OF PROSTATE CANCER IN ACCRA, GHANA

E D Yeboah  1 , A W Hsing  2   3 , S Mante  4 , J E Mensah  1 , M Y Kyei  1 , J Yarney  1 , V Vanderpuye  1 , K Beecham  1 , Y Tettey  1 , R B Biritwum  1 , A A Adjei  1 , R Gyasi  1 , K Asante  1 , K N Ampadu  1 , G O Klufio  1 , S Gepi-Attee  1 , C Owoo  1 , D Kwami  1 , Ahiaku  5 , R Pandra  6 , M B Cook  3
Affiliations

MANAGEMENT OF PROSTATE CANCER IN ACCRA, GHANA

E D Yeboah et al. J West Afr Coll Surg. 2016 Oct-Dec.

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%.

Conclusion: 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.

Keywords: Gleason score; Hormonal therapy; Management; Prostate cancer; Radiation therapy; Radical prostatectomy; Stage.

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Figures

Fig. 1:
Fig. 1:. T stages of Prostate Cancer
Fig 2a:
Fig 2a:. Age Ranges of the patients
Fig 2b:
Fig 2b:. Initial PSA levels of the patient
Fig 2c:
Fig 2c:. Biopsy methods used
Fig. 2d:
Fig. 2d:. TNM Stage
Fig 3:
Fig 3:. RADICAL PROSTATECTOMY n = 86 T1T2 N0M0 PC PRE VS POST TREATMENT PSA
Fig 4:
Fig 4:. BRACHYTHERAPY 61 cases T1 T2 N0M0 of PC
Fig 5:
Fig 5:. EBRT for 137 cases T1 T2 N0M0 of PC PRE VS POST Treatment PSA
Fig. 6a:
Fig. 6a:. LOCALLY ADVANCED PC Rx BRACHYTHERAPY PRE & POST Rx
Fig. 6b:
Fig. 6b:. PRE VS POST TREATMENT PSA LOCALLY ADVANCE PC T3 T4 N0M0D TREATED BY EBRT
See this image and copyright information in PMC

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