Prostate cancer characteristics: A descriptive analysis of clinical features at presentation in the last decade in a black African community.

Background: Prostate cancer, previously reported as relatively rare in Nigeria, is currently the leading cancer and leading cause of cancer-related death in men. Late presentation appears to persist despite higher incidence rates and instituted awareness programs. This study assesses current prostate cancer indices at presentation to a 3rd tier referral hospital in South-east Nigeria and compares these indices with reported indices from previous decades. Materials and Methods: Retrospectively, the medical records of men presenting with histologically confirmed prostate cancer from January 2009 to April 2018 were reviewed. Age, spectrum and duration of clinical features, serum total prostate-specific antigen (tPSA), and prostate biopsy specimen Gleason Score (GS) at presentation were retrieved for the analysis using the SPSS software version 21. Obtained mean values and proportions were compared to reports from previous decades for observable shifts. Results: The medical records of 331 men 51-90 years of age (mean: 69.8 ± 8.0 years) were retrieved. Six (1.8%) men (median tPSA = 28.0 ng/ml; range 10.0-121.4 ng/ml) had screening-detected prostate cancer. About 72.0%, 52.0%, and 30.3% of men present with symptoms after 3 months, 6 months, and 12 months, respectively, and about 55.1% had other clinical features of disease progression beyond lower urinary tract symptoms. Symptom duration, serum tPSA (median 31.4 ng/ml; range 4.0-710.0 ng/ml), and % fPSA (median 20.6%; range 57.1%-8.6%) at presentation, as well as prevalent poorly-differentiated tumor (GS ≥7 [4 + 3] 62.2%) are yet to shift from reports from previous decades. Conclusions: Prostate cancer indices at presentation in South-eastern Nigeria, a resource-poor community in sub-Saharan Africa are yet to positively shift despite efforts at prostate cancer awareness.

RésuméContexte: Le cancer de la prostate, déjà signalé comme relativement rare au Nigeria, est actuellement le principal cancer et la principale cause de décès par cancer chez les hommes. La présentation tardive semble persister malgré des taux d'incidence plus élevés et des programmes de sensibilisation ont été mis en place. Cette étude évalue les indices actuels du cancer de la prostate à la présentation à un hôpital de référence de troisième niveau dans le sud-est du Nigeria, et compare ces indices avec les indices rapportés des décennies précédentes. Méthodes: Rétrospectivement, les dossiers médicaux des hommes présentant un cancer de la prostate confirmé par histologie de janvier 2009 à avril 2018 ont été examinés. L'âge, le spectre et la durée des caractéristiques cliniques, l'antigène prostatique total sérique spécifique (tPSA) et l'échantillon de biopsie de la prostate Gleason Score (GS) à la présentation ont été récupérés pour analyse à l'aide de la version 21 de SPSS. Les valeurs moyennes et les proportions obtenues ont été comparées aux rapports des décennies précédentes sur les changements observables. Résultats: Les dossiers médicaux de 331 hommes âgés de 51 à 90ans (moyenne : 69,8 8,0 ans) ont été récupérés. Six hommes (1,8 %) (tPSA médiane = 28,0ng/ml; plage de 10,0 à 121,4ng/ml) avaient un cancer de la prostate dépisté. Environ 72,0%, 52,0% et 30,3% des hommes présentent des symptômes après 3mois, 6mois et 12mois respectivement, et environ 55,1% présentent d'autres caractéristiques cliniques de la progression de la maladie au-delà des symptômes des voies urinaires inférieures (LUTS). La durée des symptômes, le tPSA sérique (médiane de 31,4 ng/ml; fourchette de 4,0 à 710 ng/ml) et le %fPSA (médiane de 20,6 %; fourchette de 57,1 à 8,6 %) à la présentation, ainsi que la tumeur mal différenciée prévalente (GS 7{4+3} 62,2 %) ne sont pas encore passés des rapports des décennies précédentes. Conclusions: Les indices du cancer de la prostate présentés dans le sud-est du Nigeria, une communauté noire africaine pauvre en ressources, n'ont pas encore changé de façon positive malgré les efforts de sensibilisation au cancer de la prostate. Mots-clés: Présentation à l'hôpital; Nigéria; Cancer de la prostate; Changements temporels.

The relationship between prevalence and severity of lower urinary tract symptoms (LUTS), and body mass index and mid-abdominal circumference in men in a resource-poor community in Southeast Nigeria: a cross-sectional survey.

BACKGROUND: There is paucity of information on the community-based prevalence and severity of lower urinary tract symptoms (LUTS) in men who are 40 years and older in the southeast region of Nigeria. This study seeks to determine the community-based prevalence of LUTS and the relationship between LUTS, and body mass index (BMI) and mid-abdominal circumference (MAC) in men. METHODS: An interviewer-administered, questionnaire-based survey. Three of nine settlement clusters were randomly selected while systematic random sampling of 1 in 3 eligible subjects was used to select participants. Analysis was done using SPSS® version 20. RESULTS: One thousand three hundred and nineteen duly completed questionnaires were analyzed. The respondents are within ages 40-92 years with mean age 54.2 ± 10.2 years, mean BMI 25.97 ± 4.18Kg/m2 and mean MAC 89.80 ± 12.43 cm. Overall prevalence of LUTS is 20.2%. Nocturia at a prevalence of 19.2% is the most prevalent lower urinary tract symptom and also the earliest to manifest. LUTS prevalence and severity increases with increasing age. About 9.6% report moderate LUTS while 2.3% report severe LUTS. Storage LUTS are reported more frequently than voiding LUTS. LUTS did not vary significantly with BMI, MAC or Wealth-Index. CONCLUSION: LUTS prevalence and severity vary with age, but not with BMI, MAC or Wealth-Index.

Informed consent for clinical treatment in low-income setting: evaluating the relationship between satisfying consent and extent of recall of consent information.

BACKGROUND: Treatment informed consent aims to preserve the autonomy of patients in the clinician - patient relationship so as to ensure valid consent. An acceptable method of evaluating understanding of consent information is by assessing the extent of recall by patients of the pieces information believed to have been passed across. When concerns are not satisfactorily addressed from the patients' perspective, recall of consent information may be low. METHODS: This study is a questionnaire - based cross - sectional interview of consecutive adult surgical patients who could give their respective medical histories and who were booked for elective major surgical procedures over a period of 7 months in a tertiary health institution in southeastern Nigeria. Four to five days after a formal consent session, during ward admission, extent of recall of information on the nature of the disease condition or diagnosis, the nature of the planned procedure and the risks involved in the planned procedure were assessed and analyzed on the background of how satisfying the consent sessions were from individual patient's perspective. RESULTS: Generally, the recall of nature of disease condition and nature of planned procedure is better than recall of risks involved in the planned procedure. More specifically however, recall in these 3 domains is significantly better among the patients that affirmed that their concerns were satisfactorily addressed. CONCLUSION: The findings from this study support that no effort should be spared in ensuring that the consent information are satisfying to the patients from the patients' viewpoint.

Predicting Gleason score using the initial serum total prostate-specific antigen in Black men with symptomatic prostate adenocarcinoma in Nigeria.

BACKGROUND: Men of Black African descent are known to have the highest incidence of prostate cancer. The disease is also more aggressive in this group possibly due to biologically more aggressive tumor or late presentation. Currently, serum prostate-specific antigen (PSA) assay plays a significant role in making the diagnosis of prostate cancer. However, the obtained value of serum PSA may not directly relate with the Gleason score (GS), a measure of tumor aggression in prostate cancer. This study explores the relationship between serum total PSA at presentation (iPSA) and GS. PATIENTS AND METHODS: The iPSA of patients with histologically confirmed prostate cancer was compared with the obtained GS of the prostate biopsy specimens. The age of the patients at presentation and the prostate volumes were also analyzed with respect to the iPSA and GS. The data were analyzed retrospectively using IBM SPSS Version 20. Pearson correlation was used for numeric variables, whereas Fisher's exact test was used for categorical variables. Significance was set at P≤0.05. RESULTS: There were 205 patients from January 2010 to November 2013 who satisfied the inclusion criteria. iPSA as well as age at presentation and prostate volume were not found to significantly correlate with the primary Gleason grade, the secondary Gleason grade, or the GS. However, the presence of distant metastasis was identified to significantly correlate positively with GS. CONCLUSION: GS may not be confidently predicted by the iPSA. Higher iPSA does not correlate with higher GS and vice versa.