Factors influencing patient survival in a group of men with prostate cancer in Yaoundé, Cameroon

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Purpose: We evaluated the survival time of patients with stage D cancer of the prostate (CaP) in Yaounde, Cameroon, so as to lay the groundwork for evaluating patient management and outcomes in such communities in sub-Saharan Africa. Patients and Materials: A cohort of 200 patients was recruited at diagnosis and followed over a 171 month period. They had a standard work-up and staging protocol except for the absence of bone scan. Treatment was offered after they were staged following the Whitemore ABCD-system. Standard statistical analysis was performed for quantitative variables and graphs developed for continuous variables. Pearson correlation and Chi-square tests were used to evaluate associations between variables. The Kaplan-Meier product-limit method was used to estimate survival functions and log-rank test to compare data from complete survival curves. The statistical significance level was fixed at p values less than or equal to 0.05. Results: The mean age of our patients was 67 years and 41.5% of them were in the 60-69 year-bracket. Survival was worse for those 66 years and older (p = 0.013). Patient survival correlated with tumor differentiation such that a Gleason score of 6 or greater meant diminished survival time (p = 0.014). For the entire group, median overall survival was 40.5 months, 44% at 5 years and 17% at 10 years. Patients who received multi-modal therapy (complete androgen ablation by surgical and medical means, and radiation to the pelvis and metastatic sites) seemed to have the best survival (p < 0.001) although patient stratification into treatment groups was not randomized. A comparison of survival of African-American cohorts and this group showed no statistical significance (p = 0.1). Conclusion: Survival of patients with prostate cancer in Yaounde is just as low as in African-Americans. Survival is worse however, for men older than 66 years in Yaounde. A call for comparative and collaborative clinical trials is made.

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