Prostate Cancer Screening, Detection and Treatment Practices, Among Sub-Saharan African Urologists

Abstract

Introduction: Prostate cancer is reported to be the leading cancer in men in Sub-Saharan Africa (SSA) and the number of prostate cancer deaths is expected to double in the next 20 years. Despite the importance of this public health issue in SSA, there remains relatively limited information about practices related to prostate cancer treatment in this population. Objective: We conducted a survey of 28 urology practices in SSA to evaluate the scope of available screening, detection and treatment. Materials and Methods: Screening was more commonly reported as a part of general medical care in South Africa (SA) compared with East or West (EW) Africa. However, use of digital Rectal Examination (DRE) and Prostate Specific Antigen (PSA) were used at similar rates for screening in all locations. Screening is primarily focused in men over age 50 and those with symptoms. Routine screening was the primary reason for screening use in SA, while symptoms were the primary reason for screening use in EW. Financial and cultural barriers to screening were more commonly reported in EW than SA. Similar detection approaches were used in all regions, with free PSA and PSA velocity being more commonly used in SA than EW. Six core biopsies were more commonly used in EW and 12 core biopsies were more common in SA. Trans urethral ultrasounds and bone scans were more commonly used in SA than EW. Treatment options were similar in all regions, with brachytherapy less likely to be used in EW than SA. Results: The descriptive data suggest that differences in patterns of screening, detection and treatment exist across Africa. Differences by geography may also reflect differences in SES and racial composition of the populations in each region.

Key Words: Prostate cancer, Screening and Detection, Practice guidelines, Sub-Saharan Africa