Morphological features of prostate cancer diagnosed in the ten regions of Cameroon from 2008 to 2015

Sciences morphologiques, University of Yaounde 1
June, 2017


Prostate cancer is a disease of increasing significance worldwide. In many industrialized nations, prostate cancer(Pca) is one of the most common cancers and among the leading causes of cancer deaths. Worldwide, in 2012 there were estimated to be 1,112,000 new cases of prostate cancer and 308,000 prostate cancer deaths, making it the second most commonly diagnosed cancer in men and the fifth leading cause of male cancer death. According to GLOBOCAN 2012 , PCa incidence and mortality rates in Africa were reported to be 23.2 and 17.0 per 100,000, respectively. While this was relatively lower than reported in some other world regions, some authors argued that African men suffer disproportionately from Pca compared to many parts of the world. Despite this seemingly disproportionate burden and the prevailing challenges, it is still quite difficult to precisely describe the burden of PCa in Africa. In the West African sub-region, the study of the epidemiology of prostate cancer remains a wish rather than an accomplished quest. In Cameroon Angwafo et al reported a high prostate cancer prevalence of 195 69/100 000 men in Dibombari. Sow et al reported majority of patients in Cameroon with prostate cancer consult with clinically advanced stages of the disease and its complications. This disparity between the high prevalence and the late presentation at time of diagnosis constitutes major public health burden due to prostate cancer. There is paucity of data concerning the morphological features of cancer diagnosed in all the regions of Cameroon. In order to orientate public health policies with regards to screening and early diagnosis of prostate cancer, we therefore sought to carry out this study to describe the morphological features of prostate cancer diagnosed in the ten regions of Cameroon.
We carried out a retrospective crossectional study from the 1st of January 2008 to the 31st of December 2015(a period of 8 years) in the hospitals of the ten regional headquarters of Cameroon. Ethical clearance for this study was obtained from the scientific and ethical committee of the Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaounde I .We included all cases of prostate cancer diagnosed clinically and or histologically. Data on socio-demographic characteristics, past history, clinical characteristics and morphological characteristics were obtained using a data collection form. Data were analyzed using SPSS version 23.0, and STATA 13.The chi-square test or Fischer test where appropriate, was used to evaluate association between qualitative variables, Spearman correlation was used to evaluate association between non parametric quantitative variables. Odds ratio was used to assess the degree of association that could exist between variables. The threshold for statistical significance was set at a p-value less than 0.05.
A total of 814 cases were collected in our study. The mean age was 69 ± 9.2years .The majority of cases were diagnosed between 70 to 80 years. 469(57%) of cases were confirmed histologically. Almost all (98.1%) cancers were adenocarcinomas. Urine outflow obstruction was the most frequent medical complain. The majority of patients presented with clinically advanced stages of prostate cancer. Stage T4 was the most reported tumor stage. Gleason scores of 7 and above were the most reported scores of histologically confirmed adenocarcinoma. High Gleason scores were not significantly associated with high PSA levels. The percentage of patients diagnosed with a high Gleason score increased with age. There was a positive correlation between age and the total PSA levels(P=0.01).
The incidence of prostate cancer in Cameroon is 5.98 per 100000.This is lower than the general average for African men. The majority of patients in Cameroon present clinically advanced stages of prostate cancer. PSA values increase with age in Cameroonian men.
High PSA values are not suggestive of advanced prostate cancer in Cameroonian men.
A high proportion of prostate cancer cases in Cameroon are not confirmed histologically.
We recommend: the adoption and implementation of a screening policy for prostate cancer adapted to the socio-demographic profile of Cameroonian patients, to encourage early diagnosis of prostate cancer; the training of more physicians in the field of morbid anatomy to confirm diagnosis of clinically diagnosed cancer and the histological confirmation of clinically diagnosed prostate cancer.

Key words: Prostate cancer, Cameroon,Gleason