Evaluation of 4, 672 routine prostate biopsies performed in six African countries

Purpose: Prostate cancer (CaP) is the leading cancer diagnosed in Sub-Saharan Africa (SSA). However, relatively little is known about the clinical detection of CaP in SSA. In order to evaluate CaP detection in SSA, we evaluated the outcomes of prostate biopsies under conditions of usual clinical care. Methods: Retrospective data were collected from 4, 672 Black African men, who underwent prostate biopsy in Gaborone, Botswana; Accra, Ghana; Dakar, Senegal Cape Town, South Africa; Wadmedani, Sudan; and Kampala, Uganda. Clinical and pathological characteristics were collected using medical records information for prostate biopsies that were undertaken during the period 2005-2011. Comparison groups of White South Africans (N = 398) who underwent prostate biopsy, and African American (AA; N = 117) and European American (EA; N = 975) men with prostate cancer were also obtained. Results: Usual biopsy practices varied across SSA centers. The mean age at biopsy was 68.1 years (range: 25-100). The percentage of CaP identified was 11%, 36%, 43%, 48%, 87%, and 94% in Sudan, Senegal, South Africa, Ghana, Botswana, and Uganda, respectively. The Gleason scores 6 and 7 were predominant in Botswana, Senegal, and South Africa while the Gleason scores ≥ 8 were predominant in Sudan and Uganda. Compared to AA and EA, SSA and White South African men had substantially higher Gleason grade disease, and initial PSA at diagnosis was strongly associated with disease aggressiveness. Conclusions: The knowledge gained from studies of prostate cancer in Africa may in turn improve our understanding of aggressive prostate cancer diagnosed anywhere in the world.