Profile of prostate cancer in the Western Cape Province, South Africa

Little has been published about the epidemiology or profile of prostate cancer in African countries. We analyzed computerized data on 1749 men with histologically proven adenocarcinoma of the prostate seen at our institution between 1976 and 1996. Overall, 51% of the patients were older than 70 years. The race distribution was 51% mixed, 44% white and 5% black, reflecting the population distribution of our referral area. The tumor stage was locally advanced in the majority of patients [T3 in 24% and T4 in 42%] and localized [T1-2] in only 34%. Differentiation of the tumor was grade 1 in 29%, grade 2 in 26%, grade 3 in 33% and unknown in 12%. In those patients where the lymph node status was determined histologically, 45% were N1. The vast majority of patients had a radionuclide bone scan, and 45% were M1. Stage T1-2 tumors comprised 45% in white, 24% in mixed race and 42% in black patients, while T4 tumors comprised 26% in white, 55% in mixed race and 45% in black patients. In localized tumors [T1-2], the initial treatment was radiotherapy in 38%, while surveillance was elected in 34%, and radical prostatectomy was performed in 6%. In T3 and T4 tumors, the primary treatment was androgen deprivation in 60% and 86%, respectively. Hormonal therapy consisted of bilateral orchidectomy in 88% of cases, whereas estrogen was used in 5% and flutamide in 5% of patients. There was a positive correlation between locally advanced disease and poorly differentiated as well as metastatic tumors. Although only 18% of our patients were known to have died, the mean follow-up in those with T4 tumors was 28 months, compared to 47 months in those with T1-2 tumors, indicating that our patients were lost to follow-up because of death. The need for education of patients and primary health care providers is illustrated by this study. At present, serum prostate specific antigen [PSA] is not available to patients at primary care level in South Africa, and probably in most parts of Africa. This situation will have to be changed, if there is to be any hope for early detection and cure of prostate cancer in our part of the world

Tamoxifen in patients with advanced epithelial ovarian cancer

Fifty patients with advanced [FIGO] [stage III and IV] epithelial ovarian cancer were treated with tamoxifen 20 mg twice daily. Their estrogen receptor status was unknown. All patients had progressive or recurrent disease after first or second-line chemotherapy. The objective response rate was 56 percent [28 patients]. Partial responses were observed in 12 patients [24 percent], while sixteen patients [32 percent] showed stable disease. The median duration of objective responses was 7.5 months [range 4-13 months].The median survival of responding patients was 9 months [range 6-16 months].Toxicity was limited. Tamoxifen could be considered for palliation in patients with advanced pretreated epithelial ovarian carcinoma, as well as patients who cannot tolerate chemotherapy