A. Nyirimodoka1, I. N. Nzeyimana1, T. Hategekimana1,2, E. Ngendahayo1,3, F. Umurangwa3, E. Muhawenimana1,2, A. Bonane1,2, A. M. Sibomana4, Y. C. Bizumuremyi1, P. Ndagijimana1, A. G. Gasana4, E. Rwamasirabo1,3 1University of Rwanda,College Of Medicine And Health Sciences/Department Of Surgery/Mmed Urology Program,Kigali, KIGALI, Rwanda 2Kigali University Teaching hospital(CHUK),Department Of Surgery/Urology Unity,Kigali, KIGALI, Rwanda 3King Faisal Hospital,Department Of Surgery/Urology Unity,Kigali, KIGALI, Rwanda 4Rwanda Military Hospital,Department Of Surgery/Urology Unity,Kigali, KIGALI, Rwanda
Introduction: Prostate cancer remains a global health burden. Inadequate awareness, as well as insufficient diagnostic and management capacity, lead to its delayed presentation with associated morbidity and mortality in low and middle-income countries(LMICS) and in Rwanda in particular. This study described the burden, characteristics and management options of prostate cancer in Rwanda.
Methods: This observational prospective descriptive study included all Rwandan patients diagnosed histologically with prostate cancer (Pca) over 6 months in the 3 national urology units. We described their demographic and clinical characteristics and estimated age-standardized incidence rate of Pca.
Results:The study enrolled 108 Rwandans whose biopsies were positive. Their mean age was 71.3 years (SD=8.5). The age range was 44-89 years. Almost everybody consulted because of symptoms related to urinary flow. Thus 99.07% (107/108) had lower urinary tract symptoms (LUTS); 46.3% (50/108) had acute urinary retention (AUR) and 21.3% (23/108) had neurological impairment of lower limb related to spinal metastasis. Only 12.96 % (14/108) had a positive family history and 39.81% (43/108) didn't know about their family history. The mean symptoms duration was 12 months and 90.74 % (98/108) had symptoms lasting more than 3 months prior to the consultation. The prostate specific antigen (PSA) was high with 85.05 % (91/107) having PSA >20 ng/ml. A total PSA >20 ng/ml correlated with having metastatic disease (adjusted odd ratio (aOR) = 13.22, p-value = 0.026). The mean PSA was 100ng/ml; range 1.69-10000 ng/ml. Most patients presented with advanced disease as 37.96% (41/108) were metastatic; 26.85% (29/108) locally advanced; 18.52% (20/108) were localized and 16.67% (18/108) were not fully staged. The majority had high grade tumor where 74.07% (80/107) had a Gleason score of 8 or more and a mean Gleason sum of 8. Among 67 patients treated, androgen deprivation therapy (ADT) was offered to 76.12% (51/67) as primary treatment and 14.92% (10/67) were on ADT while waiting for combining with curative radiotherapy; 8.96% (6/67) underwent radical Prostatectomy during the study period. Bilateral orchidectomy was offered to 54.1% (33/61) and medical ADT in 45.9% (28/61). Medical ADT included goserelin which follows bicalutamide in 53.57% (15/28); cyproterone acetate in 35.71% (10/28) and ketoconazole in 10.71% (3/28). The age standardized incidence rate of prostate cancer in Rwanda is estimated at 13.56 per 100000 men above 45 years.
Conclusion: Late presentation of patients with prostate cancer generally in LMICs; Rwanda included leads to the detection of mainly advanced and high grade prostate cancer, making the clinician short of treatment options. It is imperative to increase access to health care facilities while raising awareness of prostate cancer among the general population to tackle the mortality and morbidity associated with unnecessary delays.