Prognostic factors for overall survival of patients with prostate cancer in Kyadondo county, Uganda

Abstract

Background: Prostate cancer (PCa) remains the most common cancer among men in sub-Saharan Africa (SSA). Uganda has the highest incidence and mortality of PCa in the East Africa region. The overall survival of patients with PCa in the SSA in which Uganda is included has been reported to be generally poor. Gleason score and lymphovascular invasion are the pathologic prognostic factors that can predict the overall survival of patients with PCa independently. Objective: The aim of this study was to determine the 3-year overall survival (OS) of the patients and also correlate it with the pathologic prognostic factors of patients who were diagnosed histologically with PCa from 2012 to 2014 in Kyadondo County, Uganda. Materials and Methods: This was a retrospective cohort study which included 136 patients with PCa who were diagnosed histologically at the department of Pathology, Makerere College of Health Sciences between 2012 and 2014. The patients were registered at Kampala Cancer Registry and followed-up for 3 years from January 2012 to 31st December 2017. Data analysis was done using SPSS version 16.0. Kaplan-Meir curves were used to analyze the 3-year overall survival rate. For inferential statistics when correlating between independent and dependent variables, Hazard ratio (HR) and Log-rank test were used at 95% confidence interval using both univariate and multivariate analysis under Cox-regression model. P ˂ 0.05 was considered for difference in statistical significance. Results: The mean age of the patients was 69 (45-99) years. Most of the patients, 55.1% (n = 75) had Prostate Specific Antigen (PSA) ˃20.0 ng/ml and majority of them, 67.7% (n = 92) had advanced clinical stages at diagnosis (III and IV). Lymphovascular invasion (LVI) and perineural invasion (PNI) was present in 29.4% (n = 40) and 42.5% (n = 58) patients respectively. The 3-year overall survival rate of the patients was 67.6%. Gleason score (HR = 2.84, P = 0.0001) and LVI (HR = 0.35, P = 0.002) were the prognostic factors which predicted the 3-year overall survival of the cases independently. Conclusion: Majority of patients with PCa in Uganda have both high PSA and Gleason score as well as advanced clinical stage at diagnosis. The 3-year OS of PCa patients of this study was low. GS and LVI can predict the OS of patients with PCa even during pretreatment.