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. 2021 Sep;32(9):1001-1019.
doi: 10.1007/s10552-021-01453-x. Epub 2021 Jul 10.

Prostate cancer survival in sub-Saharan Africa by age, stage at diagnosis, and human development index: a population-based registry study

Tobias P Seraphin  1 , Walburga Y Joko-Fru  2   3 , Shyam S Manraj  4 , Eric Chokunonga  5 , Nontuthuzelo I M Somdyala  6 , Anne Korir  7 , Guy N'Da  8   9 , Anne Finesse  10 , Henry Wabinga  11 , Mathewos Assefa  12 , Freddy Gnangnon  13 , Rolf Hansen  14 , Nathan G Buziba  15 , Biying Liu  2 , Eva J Kantelhardt  16   17 , Donald M Parkin  3   18
Affiliations

Prostate cancer survival in sub-Saharan Africa by age, stage at diagnosis, and human development index: a population-based registry study

Tobias P Seraphin et al. Cancer Causes Control. 2021 Sep.

Abstract

Objectives: To estimate observed and relative survival of prostate cancer patients in sub-Saharan Africa (SSA) and to examine the influence of age, stage at diagnosis and the Human Development Index (HDI).

Patients and methods: In this comparative registry study, we selected a random sample of 1752 incident cases of malign prostatic neoplasm from 12 population-based cancer registries from 10 SSA countries, registered between 2005 and 2015. We analyzed the data using Kaplan-Meier and Ederer II methods to obtain outcome estimates and flexible Poisson regression modeling to calculate the excess hazards of death RESULTS: For the 1406 patients included in the survival analyses, 763 deaths occurred during 3614 person-years of observation. Of patients with known stage, 45.2% had stage IV disease, 31.2% stage III and only 23.6% stage I and II. The 1 and 5-year relative survival for the entire cohort was 78.0% (75.4-80.7) and 60.0% (55.7-64.6), while varying between the registries. Late presentation was associated with increased excess hazards and a 0.1 increase in the HDI was associated with a 20% lower excess hazard of death, while for age at diagnosis no association was found.

Conclusions: We found poor survival of SSA prostatic tumor patients, as well as high proportions of late stage presentation, which are associated with inferior outcome. This calls for investment in health-care systems and action regarding projects to raise awareness among the population to achieve earlier diagnosis and improve survival.

Keywords: Adenocarcinoma of the prostate; Africa; Cancer surveillance; Population-based cancer registration; Survival.

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Conflict of interest statement

The authors declare no potential conflicts of interest.

Figures

Fig. 1
Fig. 1
Observed (all-cause) survival for the entire study cohort (A), by age group (B), by stage (C), and Human Development Index (HDI) (D), Source HDI (http://hdr.undp.org/en/data and http://globaldatalab.org/). 1Mauritius and Eastern Cape (South Africa) excluded, since no staging information was available
Fig. 2
Fig. 2
Comparison of 1- (A), 3- (B) and 5-year (C) age-standardized relative survival with 95% confidence intervals (CI) by registry and Human Development Index (HDI)
Fig. 3
Fig. 3
Process of patient follow-up.131st December, 2017, (for Mauritius: 31st December, 2013)
Fig. 4
Fig. 4
Number of patients by age at diagnosis in years, by registry; black vertical lines indicate median age per registry
Fig. 5
Fig. 5
Distribution of stage by registry (Mauritius and Eastern Cape (South Africa) excluded)
Fig. 6
Fig. 6
Kaplan–Meier overall survival probabilities (95% confidence intervals) by registry
Fig. 7
Fig. 7
1-, 3- and 5-year relative survival with 95% confidence intervals (CI) by registry and Human Development Index (HDI); *The upper limit of Eldoret’s 95% CI is at 164%
See this image and copyright information in PMC

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