Urogenital Cancers: Epidemiological, Clinical, and Therapeutic Evolution

Abstract

Introduction: Urological cancers encompass a range of malignant tumors affecting the main organs of the urinary tract in both sexes, as well as the male genital system. In sub-Saharan Africa, available data on urogenital cancers are primarily derived from hospital-based statistics. In Senegal, the majority of urogenital cancers are diagnosed at locally advanced and/or metastatic stages. In recent years, we have observed an increasing frequency of urological cancers in our departments, accompanied by rising mortality. The aim of this study was to describe the epidemiological, clinical, and progressive characteristics of these cancers in the two hospitals of Ziguinchor, and to evaluate their management. Patients and Methods: We conducted a retrospective, multicenter, descriptive study over a 5-year period (January 1, 2018 to December 31, 2022). Included were all patients hospitalized for confirmed urogenital cancers and receiving treatment. Patients with incomplete files or followed as outpatients were excluded. The parameters studied included epidemiological, clinical, paraclinical, therapeutic, and outcome-related data. Results: We recorded 203 cases of urological cancers, with a peak in 2021 representing 26% of the cases. The most frequent cancer sites were: prostate 69% (n = 140), bladder 22% (n = 44), kidney 5% (n = 11), and testis 4% (n = 8). The mean age of patients was 66 years (range: 2 - 95 years), with the most common age group being 60 - 70 years (37%). There was a marked male predominance (91%). The average time to consultation was 95 days (range: 4 - 750 days). Dysuria, followed by pollakiuria and hematuria, were the main reasons for consultation. Total prostate-specific antigen (PSA) was assessed in all prostate cancer cases, with a mean level of 1846 ng/mL. Ultrasound and thoraco-abdominal CT scans (CT TAP) were performed in varying proportions depending on the cancer site. Treatment was predominantly surgical. During hospitalization, complications were reported in 31% (n = 62) of patients. Ten months after treatment, 29% (n = 55) demonstrated favorable outcomes, while the overall mortality rate was 12% (n = 23). However, 59% (n = 113) were lost to follow-up. Conclusion: Urogenital cancers are relatively common in routine urological practice. The confirmation of diagnosis often requires invasive procedures. In our context, a major challenge remains the late-stage diagnosis. Moreover, data are limited due to the absence of cancer registries in most African countries, including Senegal.