Patterns and Presentation of Prostate Cancer in the Brong Ahafo Region of Ghana: A 6-Year Single Center Retrospective Study

Abstract

Introduction: Prostate cancer is gradually reaching a very high incidence in Africa, especially in the Sub-saharan region. Understanding the dynamics in occurrence of the disorder is one approach to developing effective public health programmes and interventions that will help curb the rising incidence. Objective: This study was aimed at reducing the paucity of data on prostate cancer by assessing the incidence, patterns and presentation in the Brong Ahafo Region of Ghana. We sought to provide region-specific hardcore data that will help to assess the issue and provide remedies. Method and Materials: All prostate disease cases recorded from the year 2009 to 2014 were retrospectively reviewed. Subjects from 40 years (based on previous studies) and above were eligible for screening. Diagnostic and screening tools for prostate cancer at the study site were family history, serum prostate specific antigen (PSA) test, digital rectal examination, urological ultrasound scan and histopathology (biopsy). Age, PSA values and year of screening/diagnosis were also retrieved from patient folders/archives for the purposes of the study. Histological findings and parameters considered in the study included diagnosis, carcinoma grading, perineural invasion (PNI) and percentage of affected tissues (%TA). Results: Prostate cancer constituted 236 cases (40.07%) of the 589 prostate diseases reviewed. The highest annual prevalence was recorded in 2014 with an incidence rate of 21.6% (51 cases). The ages of patients ranged from 46 to 101 years with a modal age range of 70 - 79 years and a mean ± SD of 71.7 ± 11.2. The mean PSA value recorded was 37.5 ng/ml (±68.9) with predominance in the 11 - 20.9 ng/ml (61 cases/patients) (27.9%) range. Moderately differentiated adenocarcinoma was the dominant grade of prostate cancer accounting for 61.4% (145 cases) of the 236 cases. There was a significant correlation (p = 0.001) between grading of prostate cancer and perineural invasion. Only 21.2% graded cancer cases had perineural invasion with >50% affected tissues found in half of them. Conclusion: There is a high incidence (40.07%) of prostate cancer in the Brong Ahafo Region of Ghana, presenting mostly with advanced prostatic carcinoma. Reported cases also show high %TA and PNI. Development and implementation of public health interventions are needed to address some of these issues.