Prostate cancer clinicopathological presentation in South-East Africa during the 2010 decade

Abstract

Prostate cancer is the leading cause of cancer-associated death among men across Sub-Saharan Africa, with Southern and East Africa ranking first and fifth globally. However, lack of coordinated national cancer registries has biased data toward single-sourced, averaged, or model estimates. Here, our retrospective study included 8634 South-East African patients diagnosed between 2010 and 2019, which when compared with 71 694 Black and 322 356 White period-matched American men, were over threefold more likely to present with aggressive disease (International Society of Urological Pathology grade groups ≥4: 45.38% vs 21.22% and 21.05%; prostate-specific antigen ≥20 ng/mL: 62.04% vs 17.29% and 11.17%, respectively; all 2-sided P < .0001). East over Southern African men are 1.5 times more likely to present with advanced disease, however, age was not a confounder. Supporting prostate cancer as a major health concern for Africa, our data suggest underestimation in East Africa, while highlighting the need for accurate monitoring, increased awareness, and tailored screening criteria.

Figure 1.

Prostate cancer presentation in Sub-Saharan Africa. A) Map of Africa depicting regional Sub-Saharan Africa GLOBOCAN 2022 prostate cancer–associated worldwide mortality rankings as well as South-East African patient resources targeted in this study. B) Distribution (percentage) of prostate cancer International Society of Urological Pathology (ISUP) grade grouping across the study’s geo-ancestral identifiers, with further distinction using National Comprehensive Cancer Network criteria as high-/very high-risk (ISUP ≥4, orange) vs low-risk prostate cancer (ISUP <4, blue). C) Distribution (percentage) of prostate-specific antigen (PSA) levels (ng/mL) at diagnosis across the study’s geo-ancestral identifiers, with further National Comprehensive Cancer Network categorization as high-/very high-risk (PSA ≥20 ng/mL, orange) vs low-risk prostate cancer (PSA <20 ng/mL, blue). D) Box plots depicting age distribution for high-/very high-risk (ISUP ≥4, orange) vs low-risk (ISUP <4, blue) prostate cancer cases at diagnosis by South-East African country. E) Box plots depicting age distribution for high-/very high-risk (PSA ≥20 ng/mL, orange) vs low-risk (PSA <20 ng/mL, blue) prostate cancer cases at diagnosis by South-East African country. Abbreviations: E = East; GG = grade grouping; PCa = prostate cancer; S = South; SE = South-East.