Contemporary Radiation Treatment of Prostate Cancer in Africa: A Ghanaian Experience

Abstract

Purpose Data on prostate cancer (PCa) treatment in Africa remains under-reported. We present a review of the management of PCa at the cancer center of the largest tertiary referral facility in Ghana, with emphasis on curative treatment. Methods We retrospectively reviewed data on 1,074 patients seen at the National Center for Radiotherapy and Nuclear Medicine from 2003 to 2016. Patient and disease characteristics at presentation are presented using descriptive statistics. The χ² and Fisher's exact tests and Mann-Whitney U test were used to analyze differences between categorical and continuous variables, respectively. Methods of survival analysis were used to evaluate the relative risk of biochemical disease-free survival (bDFS). Results Seventy percent of the study population presented with localized disease. High-risk disease presentation accounted for 64.4% of these patients. Only 57.6% of patients with localized disease received curative radiotherapy. The 5-year overall survival for the curative cohort was 96% (interquartile range, 93% to 98%). The 5-year bDFS rates for low-, intermediate-, and high-risk groups were 95%, 70%, and 48%, respectively. Both Gleason score and pretreatment prostate-specific antigen were significant predictors for bDFS in multivariable analysis. Conclusion We show that the majority of patients with PCa have locally advanced disease at the time of presentation for radiotherapy. bDFS was significantly better for low- and intermediate-risk than for high-risk disease. These data emphasize the dire need to re-evaluate screening and patient education of PCa in regions of the world with high incidence and mortality as well as the need for improved access to care and treatment delivery.

Fig 1

Patient selection diagram.

Fig 2

Diagnostic and treatment pathways for prostate cancer. Cost of italicized items may be access limiting. cT, clinical tumor stage; CT, computed tomography; CXR, chest x-ray; DRE, digital rectal examinations; EBRT, external beam radiotherapy; KBTH, Korle Bu Teaching Hospital; mCRPCa, metastatic castrate-resistant prostate cancer; mHSPCa, metastatic hormone-sensitive prostate cancer; MRI, magnetic resonance imaging; PCa, prostate cancer; PSA, prostate-specific antigen; US, ultrasound.

Fig 3

(A) Two-dimensional plan simulation film of 0° field (borders marked in white) and (B) 2 × 2 view of three-dimensional conformal radiotherapy plan.

Fig 4

Patterns of prostate cancer presentation at the National Center for Radiotherapy and Nuclear Medicine.

Fig 5

Distribution of metastatic disease by site.

Fig 6

Kaplan-Meier curves of biochemical disease-free survival (bDFS) by (A) clinical Gleason score and (B) National Comprehensive Cancer Network (NCCN) risk group and of overall survival by (C) clinical Gleason score and (D) and NCCN risk group.