The epidemiology, histopathology and screening prospective of prostate cancer in Trinidad

Abstract

Author(s): Srikanth Umakanthan, Maryann M Bukelo, D Bissoon

Background: Prostate cancer is the most prevalent carcinoma found in males as well as the most prevalent carcinoma found in the overall male population of Trinidad. According to the Pan American Health Organization, Trinidad has one of the highest incidence and mortality rates of Prostate Cancer in the region. Factors such as age, ethnicity, diet, family and drug history all play a role in Prostate Cancer epidemiology and thus was assessed in this study. Objectives: The purpose of this study is to investigate the usefulness of prostate-specific antigen (PSA) values and digital rectal examination (DRE) findings/screening findings, to determine the histopathologic features of prostate cancer and correlate with the screening findings, and evaluate the role of positive family history, dietary patterns and drug history in proven cases of prostate cancer. Method: Clinical records from the Eric Williams Medical Sciences Complex were used to identify prospective candidates for the study. Data collection sheets were then used to collect clinically based information (PSA values and DRE findings) as well as the histopathologic results from reports requested. Additionally, a questionnaire was asked via telephone to each suitable candidate in order to obtain their respective family history, dietary patterns and drug history. The data was then analyzed and appropriate correlations were made. Results: Of 130 prostate cancer patients, the majority (42.86%) were of African ethnicity. The most common age range at which patients were first diagnosed was found to be between ages 70-75, which accounted for 31.43% of the 130 patients. The median age range for diagnosis was 65-70 years old. The most common symptom experienced by the patients was a pain in the back/hip/ribs (46.7%). Most of the patients were found to have PSA values in the range 10-20 ng/ml range (22.9% of the patients) and>100 ng/ml range in 20% of the patients. 25.74% of the sample had a family history of prostate cancer, with 20.02% being first degree relatives and 5.72% being second-degree relatives. 8.58% and 5.72% of the sample with first degree and second-degree relatives respectively were diagnosed before the aforementioned median diagnostic age indicating that men with a family history of prostate cancer are more prone to developing the disease at an earlier age. Histopathologic analysis showed all of the prostatic carcinomas were of the acinar type of adenocarcinoma with 42.30% been moderately differentiated type (Gleason score of 7). Conclusion: The results suggest that attention should be given to educating men especially those of African ethnicity, about prostate cancer so as to raise awareness. Steps should be taken to reduce the symptom of back/hip/rib pain as this is the most common occurring symptom within this population. Males over the age of 40 years with first degree relatives diagnosed with prostate cancer should undergo regular (yearly) screening examinations and be educated about their risk factors. More research into the effect of diet and the increased risk of developing prostate cancer is warranted especially in Trinidad and Tobago where the local cuisine is of unique varieties.

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