Prostate cancer among different racial groups in the Western Cape: Presenting features and management
Patients and methods. We studied all patients diagnosed with prostate cancer at the Urological Oncology Clinic, Tygerberg Hospital, from January 1995 to December 2005. Most presented symptomatically as PSA screening is not readily available in the referral area of the hospital. Race was self-defined as white, coloured or black. Statistical analysis was performed using Student’s t-test or Fisher’s exact test, where appropriate. A two-tailed p-value <0.05 was accepted as statistically significant.
Results. There were 901 patients: 291 (32.3%) white, 539 (59.8%) coloured and 71 (7.9%) black. Mean age at presentation was significantly higher in the white than the coloured and black groups (69.7, 67.9 and 68.9 years, respectively). Grade 1 adenocarcinoma was most common in the white (37%) and coloured groups (38%), and grade 2 was most common in the black group (39%). There was a significantly lower percentage of patients with T3-4 disease at diagnosis in the white group (47%) than the coloured (61%) and black (62%) groups. Mean serum PSA at diagnosis was significantly higher in the black than the coloured and white groups (766.1, 673.3 and 196.1 ng/ml, respectively). Potentially curative therapy (radical prostatectomy or radiotherapy) was chosen by 31% of white, 23% of coloured and only 12% of black patients. The mean duration of follow-up was significantly shorter in the black than in the white or coloured groups (24.0, 31.5 and 35.0 months, respectively).
(Note: if the above information is not included in the Results section, it is problematic to justify the conclusions below regarding presentation with higher PSA, receiving curative therapy less often, and shorter followup, because the data supporting these conclusions are not in the Abstract)
Conclusions. Black men presented with higher grade and stage disease and higher serum PSA, received potentially curative treatment less often, and had a shorter follow-up (probably owing to shorter survival) than the white and coloured groups. Greater prostate cancer awareness and education among patients and physicians and more widespread use of PSA screening of pre-symptomatic men at risk of prostate cancer is needed.
C F Heyns, Department of Urology, University of Stellenbosch and Tygerberg Hospital
M Fisher, Department of Urology, University of Stellenbosch and Tygerberg Hospital
Angus Lecuona, Department of Urology, University of Stellenbosch and Tygerberg Hospital
A van der Merwe, Department of Urology, University of Stellenbosch and Tygerberg Hospital
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Date published: 2011-04-04
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