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In accordance of the Creative Commons Attribution License all Copyrights © 2014 are reserved for SCIRP and the owner of the intellectual property Fasnewinde Aristide Kabore et al. Methods: We analyzed the data of a cohort of 168 consecutive patients with no prior history of PCa between January 2009 and December 2012. Patient and disease characteristics and the initial treatment offered were taken in account.
Androgen deprivation therapy (ADT) was the first therapeutic option for 121 patients (72%) and 73 patients (43.4%) underwent ADT through bilateral orchiectomy. IntroductionProstate cancer (PCa) is the second most common cause of cancer and the sixth leading cause of cancer death among men worldwide with an estimated 899,000 new cases and 258,000 new deaths in 2008 [1]. Despite this dramatically increase of the disease impact, PCa cases remain under diagnosed and underreported in Sub-Saharan Africa (SSA).
Very few data are available for PCa incidence, prevalence, aggressiveness, and mortality in men of Sub-Saharan African countries [1-3]. Previous studies in Burkina Faso are suggestive that PCa knowledge and awareness are pour in the general population [4] and that most cases are diagnosed late [5].
The aim of the present study is to provide more data concerning characteristics of newly diagnosed PCa and an overview of initial treatments offered in the most important urological center of Burkina Faso.2. Patients and MethodsWe performed a prospective and descriptive non-randomized patient’s cohort study. Newly diagnosed PCa cases were included between January 2009 and December 2012 at the urology division of the Yalgado Ouedraogo University Teaching Hospital of Ouagadougou. 168 consecutives cases were enrolled during the study period and their details entered into a database. This study did not need an ethical committee advice in Burkina Faso because it was a medical record chart abstraction study using anonymized data. PCa diagnosis was done at histological analysis of transrectal prostate biopsy (TRPB) for all the patients. The variables of interest included age at diagnosis, the clinical symptoms at the time of diagnosis, serum Prostate Specific Antigen (PSA) level, the pathological variables (the histological type and the Gleason score), the stage of tumor and the initial therapeutic options.
The existence of metastatic PCa was evaluated through clinical exam and thoraco-abdominal and pelvis computed tomography. Tumor stage was determined according to the 2009 TNM classification.Descriptive statistics were used to summarize these variables in terms of frequencies, means and standard deviation.
A low standard deviation (SD) indicates that the data points are close to the mean (the expected value).
When the standard deviation is high, it indicates that the data points are spread out over a large range of values.We also presented a scatter showing how the number of PCa has evolved over time, precisely from 2009 to 2012. A linear trend is estimated on this graph, showing the relationship between the time (X) and the number of PCa (Y).
For this estimation, the R-Squared (R2) is calculated, showing how close the data are to the fitted regression line.


Clinical FindingsAt the time of diagnosis, the age of patients ranges from 30 to 95 years, with an average of 68, 59 years and a SD of 9.41 . The majority of the patients (76.2%) were in the 60 - 69 years and 70 - 79 years age brackets (Figure 1).
Urinary retention was the first clinical patterns of reference in our center (n = 63, 37.5%).
Initial Treatment OfferedAndrogen deprivation therapy (ADT) was the first therapeutic option for 121 patients (72%). The highest rates of this disease are in North America especially in African Americans (228.5 per 100,000 men) and Caribbean men of African descent [1,6].
The access to quality health care services, availability of pathology services and the availability of cancer registries affect how rates of PCa are reported and can explain the differences betweenTable 3.
Clinical stages according to TNM classification.African Americans and their ancestry from SSA but also between Sub-Saharan African countries. According to those reasons we can postulate that the true PCa incidence in African men is probably higher than what is reported. This is strengthening by the global increased number of PCa cases in Africa through the last 2 decades [1,3,7,8]. The age of diagnosis of PCa in our study is also similar to those reported from the developed world particularly in Europe and North America [12,13].
However, the majority of PCa cases are diagnosed in patients who are asymptomatic in the developed world due to the widespread use of the Prostate Specific Antigen (PSA) blood test [12-14]. 68.7% of PCa cases were diagnosed in the absence of symptoms in the study of Muller [12] from the USA. Contrariwise the majority of patients in our study are symptomatic (95.8%) and presented with LUTS and features of locally advanced or metastatic disease. Numerous studies have found that black men have a higher stage of disease at presentation and are more likely to die of their prostate cancer than their white counterparts [15-17].
Several studies have observed a higher age-specific serum PSA values in black men without prostate cancer compared to white men [21-23]. Despite those suggestive data, the race-specific PSA is controversial and more detailed studies are needed to elucidate if this is a result of genetic predisposition or timing in the diagnosis of PCa [21-23].
In another hand, reported prostate cancer cases from Africa shared a common elevated PSA level [10,19,24].
Except the possible race-specific PSA this could be relevant to late presentation of PCa and the absence of appropriate approaches to screening in Africa.In a recent review on PCa incidence, aggressiveness, and mortality in men of African descent Reebeck et al.
Advanced and highgrade PCa among black men from the USA, Caribbean and other sub-Saharan African countries suggests an element of shared genetics disadvantage of high-risk disease but may also be due to differences in screening and availability of diagnosis resources(PSA, pathologists, urologists) [2,15,25].Bilateral orchiectomy is a common and widely used surgical procedure for advanced and metastatic PCa in Burkina Faso and generally in the developing world. At the opposite, the use of surgical ADT is declining in developed countries due to the availability of medical ADT which are considered to be equally effective in reducing testosterone levels as orchiectomy with less psychological effect [26,27].
This is the mains reason that justifies the widespread use of bilateral orchidectomy in SSA [11,19,23]. Moreover many patients in our environment are reluctant to receive medication (8.3% of patients in our study refused the treatment) and lost to follow-up after hospitalization.


Therefore, bilateral orchiectomy is a single and safe method to ensure that treatment is maintained.Radical prostatectomy remains the gold standard for treatment of organ confined prostate cancer [28,29]. It has been noted that access of patients with localized PCa to radical prostatectomy in SSA is low mainly due to lack of expertise in the procedure of open radical prostatectomy and advanced disease at diagnosis [11,23,27]. However curative management of prostate cancer through radical prostatectomy and radiotherapy depends on early detection of the disease. Despite those limitations this study have the merit to complete data from Burkina Faso and provide an overview of newly diagnosed PCa characteristics and treatment in the most important referral center for patients with urological diseases from all over the country. Further multicentric studies are needed to better access the PCa epidemiology disease characteristics and treatment outcomes in Burkina Faso.5. Screening for PCa could help detect earlier stage PCa and improve the treatment outcome in Burkina Faso. Parkin, “Estimates of Worldwide Burden of Cancer in 2008: GLOBOCAN 2008,” International Journal of Cancer, Vol. Parkin, “Trends in the Incidence of Cancer in the Black Population of Harare, Zimbabwe 1991- 2010,” International Journal of Cancer, Vol.
Ananaba, “Emergent Trends in the Reported Incidence of Prostate Cancer in Nigeria,” Clinical Epidemiology, Vol. Mensah, “Clinicopathologic Features and Determinants of Gleason Score of Prostate Cancer in Ghanaian Men,” Urologic Oncology: Seminars and Original Investigations, Vol. Gueye, “Management of Prostate Cancer in Senegal: What Is Being Done?” Progres en Urologie, Vol. Bergman, et al., “Prostate Cancer Severity among Low Income, Uninsured Men,” The Journal of Urology, Vol. Gnanapragasam, “Changing Presentation of Prostate Cancer in a UK Population—10 Years Trends in Prostate Cancer Risk Profiles in the East of England,” British Journal of Cancer, Vol. Cooperberg, “The Epidemiology of High-Risk Prostate Cancer,” Current Opinion in Urology, Vol.
Obiorah, “Age and Pathology of Prostate Cancer in South-Southern Nigeria; Is There a Pattern?” Medical Journal of Malaysia, Vol. Yarney, “Early Results of Prostate Cancer Radiation Therapy: An Analysis with Emphasis on Research Strategies to Improve Treatment Delivery and Outcomes,” BMC Cancer, Vol.
Jemal, “Prostate Cancer Disease Severity and Country of Origin among Black Men in the United States,” Prostate Cancer and Prostatic Disease, Vol. Derweesh, “Survival Outcomes in Men Receiving Androgendeprivation Therapy as Primary or Salvage Treatment for Localized or Advanced Prostate Cancer: 20-Year Single-Centre Experience,” BJU International, Vol. Walsh, “Radical Prostatectomy for Localized Prostate Cancer Provides Durable Cancer Control with Excellent Quality of Life: A Structured Debate,” The Journal of Urology, Vol.



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