A comparison of clinicopathologic features of prostate cancer between Nigerian and South African black men

Ridwan Oladotun Ahmed; Vikash Sewram; Adisa Rasaaq Oyesegun; Birhanu Ayele; Abrie van Wyk; Pedro Fernandez

doi:10.1186/s12301-022-00273-y

A comparison of clinicopathologic features of prostate cancer between Nigerian and South African black men

Afr J Urol. 2022;28(1):6. doi: 10.1186/s12301-022-00273-y. Epub 2022 Mar 5.

Authors

Ridwan Oladotun Ahmed^{1

2

3}, Vikash Sewram¹, Adisa Rasaaq Oyesegun², Birhanu Ayele¹, Abrie van Wyk⁴, Pedro Fernandez⁵

Affiliations

¹ African Cancer Institute, Department of Global Health, Stellenbosch University, PO Box 241, Tygerberg, 8000 South Africa.
² Department of Radiotherapy and Oncology, National Hospital, Plot 132, Central District (Phase II), P.M.B 425, Garki, Abuja, Nigeria.
³ Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, HA6 2RN UK.
⁴ Division of Anatomical Pathology, Department of Pathology, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa.
⁵ Division of Urology, Department of Surgical Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000 South Africa.

Abstract

Background: Globally, prostate cancer (PCa) is the commonest non-cutaneous male malignancy. It is more aggressive among black men with little known reasons as to the cause and continued trend among black men. This disproportionate pattern of PCa especially among black men of African ancestry resident in Africa calls for a closer look. Nigeria and South Africa, combined, have the highest cumulative risk incidence of PCa in Africa. The present study investigated the clinicopathologic behaviour of PCa among Nigerian and South African black men and the relationship between the disease and socio-demographic characteristics alongside medical co-morbidities.

Methods: A retrospective cross-sectional study was undertaken in which de-identified records of 234 black men with pathologically confirmed PCa between 2007 and 2017 from two tertiary hospitals, in Nigeria (National Hospital, Abuja) and South Africa (Tygerberg Hospital, Cape Town), were reviewed.

Results: Median age at presentation from both countries was 66 years (interquartile range, IQR 61-73 years) while the median PSA at presentation was 46 ng/ml (IQR 16-336.5 ng/ml). Half of the men (117/234) presented with locally advanced disease while metastatic disease was observed in 65.9% (27/41) of Nigerian men and 34.1% (14/41) of South African men. Thirty-three per cent of the men presented with organ-confined disease. Overall, Nigerian men presented with less organ-confined disease and significantly higher stage of disease (p < 0.001). Risk stratification using PSA, Gleason scores and T-staging showed that 84.2% (n = 197) of all the men presented with high-risk PCa disease. There was a statistically significant difference between Nigerian and South African black men (p = 0.003) in terms of disease risk at presentation. Logistic regression analysis showed that age (Adjusted OR 1.053 (95% CI 1.003-1.106), p = 0.003) and country of residence (Adjusted OR 4.281 (95% CI 1.690-10.844), p = 0.002) had a statistically significant relationship with high risk of PCa while disease co-morbidities (like diabetes and hypertension) and rural/urban location in both countries did not.

Conclusions: Disparities exist between PCa presentation and clinicopathologic behaviour among Nigerian and South African black men. Nigerian men showed higher disease risk at presentation. Environmental-genetic interactions need further exploration in the aetio-pathogenesis of PCa in black men of African ancestry.

Keywords: African ancestry; Age; Black men; Gleason score; PSA; Prostate cancer; Risk factors.