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      Contemporary Radiation Treatment of Prostate Cancer in Africa: A Ghanaian Experience

      , , , , , , , , , , , ,

      Journal of Global Oncology

      American Society of Clinical Oncology

      261-137-3222, External beam radiotherapy, 16, 261-436-2730, Androgen deprivation therapy, 12, 261-137-2661, Brachytherapy, 11, 130-540-541, Treatment planning, 9, 281-5277-9249, Gleason grading system, 8, 613-4678-146-3542, Orchiectomy, 7, 261-137, Radiation therapy, 6, 613-135-444, Cancer incidence, 6, 283-183-180, Prostate cancer, 2, 281-318-5774, Localized cancer, 2, 281-5277-5594, High risk disease, 2, 273, busulfan, 2, 138, goserelin, 1, 249, leuprolide, 1, 238, bicalutamide, 1, 38092-22498, ESR1, 1

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          Abstract

          Purpose

          Data on prostate cancer (PCa) treatment in Africa remains under-reported. We present a review of the management of PCa at the cancer center of the largest tertiary referral facility in Ghana, with emphasis on curative treatment.

          Methods

          We retrospectively reviewed data on 1,074 patients seen at the National Center for Radiotherapy and Nuclear Medicine from 2003 to 2016. Patient and disease characteristics at presentation are presented using descriptive statistics. The χ 2 and Fisher’s exact tests and Mann-Whitney U test were used to analyze differences between categorical and continuous variables, respectively. Methods of survival analysis were used to evaluate the relative risk of biochemical disease-free survival (bDFS).

          Results

          Seventy percent of the study population presented with localized disease. High-risk disease presentation accounted for 64.4% of these patients. Only 57.6% of patients with localized disease received curative radiotherapy. The 5-year overall survival for the curative cohort was 96% (interquartile range, 93% to 98%). The 5-year bDFS rates for low-, intermediate-, and high-risk groups were 95%, 70%, and 48%, respectively. Both Gleason score and pretreatment prostate-specific antigen were significant predictors for bDFS in multivariable analysis.

          Conclusion

          We show that the majority of patients with PCa have locally advanced disease at the time of presentation for radiotherapy. bDFS was significantly better for low- and intermediate-risk than for high-risk disease. These data emphasize the dire need to re-evaluate screening and patient education of PCa in regions of the world with high incidence and mortality as well as the need for improved access to care and treatment delivery.

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          Most cited references 21

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          Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference.

          In 1996 the American Society for Therapeutic Radiology and Oncology (ASTRO) sponsored a Consensus Conference to establish a definition of biochemical failure after external beam radiotherapy (EBRT). The ASTRO definition defined prostate specific antigen (PSA) failure as occurring after three consecutive PSA rises after a nadir with the date of failure as the point halfway between the nadir date and the first rise or any rise great enough to provoke initiation of therapy. This definition was not linked to clinical progression or survival; it performed poorly in patients undergoing hormonal therapy (HT), and backdating biased the Kaplan-Meier estimates of event-free survival. A second Consensus Conference was sponsored by ASTRO and the Radiation Therapy Oncology Group in Phoenix, Arizona, on January 21, 2005, to revise the ASTRO definition. The panel recommended: (1) a rise by 2 ng/mL or more above the nadir PSA be considered the standard definition for biochemical failure after EBRT with or without HT; (2) the date of failure be determined "at call" (not backdated). They recommended that investigators be allowed to use the ASTRO Consensus Definition after EBRT alone (no hormonal therapy) with strict adherence to guidelines as to "adequate follow-up." To avoid the artifacts resulting from short follow-up, the reported date of control should be listed as 2 years short of the median follow-up. For example, if the median follow-up is 5 years, control rates at 3 years should be cited. Retaining a strict version of the ASTRO definition would allow comparisons with a large existing body of literature.
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            Use of normal tissue complication probability models in the clinic.

            The Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) review summarizes the currently available three-dimensional dose/volume/outcome data to update and refine the normal tissue dose/volume tolerance guidelines provided by the classic Emami et al. paper published in 1991. A "clinician's view" on using the QUANTEC information in a responsible manner is presented along with a description of the most commonly used normal tissue complication probability (NTCP) models. A summary of organ-specific dose/volume/outcome data, based on the QUANTEC reviews, is included. Copyright 2010 Elsevier Inc. All rights reserved.
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              Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial.

              We did a randomised phase III trial comparing external irradiation alone and external irradiation combined with an analogue of luteinising-hormone releasing hormone (LHRH) to investigate the added value of long-term androgen suppression in locally advanced prostate cancer. Between 1987 and 1995, 415 patients were randomly assigned radiotherapy alone or radiotherapy plus immediate androgen suppression. Eligible patients had T1-2 tumours of WHO grade 3 or T3-4 N0-1 M0 tumours; the median age of participants was 71 years (range 51-80). In both treatment groups, 50 Gy radiation was delivered to the pelvis over 5 weeks, and 20 Gy over 2 weeks as a prostatic boost. Goserelin (3.6 mg subcutaneously every 4 weeks) was started on the first day of irradiation and continued for 3 years; cyproterone acetate (150 mg orally) was given for 1 month starting 1 week before the first goserelin injection. The primary endpoint was clinical disease-free survival. Analyses were by intention to treat. 412 patients had evaluable data, with median follow-up of 66 months (range 1-126). 5-year clinical disease-free survival was 40% (95% CI 32-48) in the radiotherapy-alone group and 74% (67-81) in the combined-treatment group (p=0.0001). 5-year overall survival was 62% (52-72) and 78% (72-84), respectively (p=0.0002) and 5-year specific survival 79% (72-86) and 94% (90-98). Immediate androgen suppression with an LHRH analogue given during and for 3 years after external irradiation improves disease-free and overall survival of patients with locally advanced prostate cancer.
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                Author and article information

                Journal
                J Glob Oncol
                J Glob Oncol
                jgo
                jgo
                JGO
                Journal of Global Oncology
                American Society of Clinical Oncology
                2378-9506
                2018
                09 July 2018
                : 4
                Affiliations
                Francis A. Asamoah, Shivanshu Awasthi, Puja S. Venkat, Angelina K. Fink, Arash O. Naghavi, Peter A.S. Johnstone, and Kosj Yamoah, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL; and Francis A. Asamoah, Joel Yarney, Verna Vanderpuye, Afua Abrahams, James E. Mensah, Evans Sasu, and Samuel N.A. Tagoe, Korle Bu Teaching Hospital, Accra, Ghana, West Africa.
                Author notes
                Corresponding author: Kosj Yamoah, MD, PhD, Department of Radiation Oncology and Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612; e-mail: kosj.yamoah@ 123456moffitt.org .
                Article
                1700234
                10.1200/JGO.17.00234
                6223508
                30085846
                © 2018 by American Society of Clinical Oncology

                Creative Commons Attribution Non-Commercial No Derivatives 4.0 License: https://creativecommons.org/licenses/by-nc-nd/4.0/

                Page count
                Figures: 6, Tables: 3, Equations: 0, References: 32, Pages: 13
                Product
                Categories
                610, Radiation Oncology
                50.400, Epidemiology
                610, Radiation Oncology
                Original Report
                Custom metadata
                v1

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