Prostate cancer in Southern Africa : does Africa hold untapped potential to add value to the current understanding of common disease?

Abstract

Prostate cancer (PCa) is the most common cancer diagnosis in men from economically stable countries and is a leading cause of cancer-related death.1 However, the population with the highest reported incidence and mortality rates globally are African Americans. Although the lifetime risk of a cancer diagnosis (one in two) or cancerassociated mortality (one in four) is no different for American men of African or European heritage, the figures are dramatically skewed for PCa.2 Incidence and mortality rates are 1.6- and 2.4-fold greater for African Americans than for European Americans, respectively.3 Additional clinical parameters exasperated in African Americans are higher serum prostate-specific antigen (PSA) levels population wide and at diagnosis, younger age at diagnosis, shorter PSA doubling before surgery, higher tumor grade and volume at surgery, higher incidence of anteriorally located tumors (more challenging to obtain a biopsy sample), and faster growing tumors (greater potential for metastasis).4-10 Although African American men have the greatest PCa burden globally, the relationship to men from Africa is less clear. We present the challenges and largely overlooked potential to address the impact of PCa within Africa. We provide commentary from our experiences as the clinical (M.S.R.B.) and scientific (V.M.H.) directors of the Southern African Prostate Cancer Study (SAPCS).