PROSTATE CANCER IN JAMAICA

Transcription

1 PROSTATE CANCER IN JAMAICA LOCAL PROFILE OF PROSTATE CANCER - A review of TRUS biopsy data DR MARIE BROWN (ELECTIVE RESIDENT) 1

2 OBJECTIVES Background on Jamaica/ Jamaicans Review the incidence and mortality rate of Prostate cancer in Jamaica and compare to other countries Present the local data on prostate biopsy findings at one institution To identify the need for prostate cancer screening in a high risk population Total area 10,991 sq km 2

3 Population of 2.73M 93.7% black 6.1% mixed 0.8% East Indians Other 0.4% Highest population density Kingston and Montego Bay WHO country statistics and global health estimates 2015 AGE DISTRIBUTION >65 years 7.94% WHO country statistics and global health estimates

4 AGE DISTRIBUTION Median age Male 25.1 years Female 26.1 years Life expectancy at birth Male 72 years Female 75.3 years Healthy life expectancy 64 years WHO country statistics and global health estimates

5 CAUSES OF REDUCED LIFE EXPECTANCY WHO country statistics and global health estimates 2015 WHO TOP 10 CAUSES OF DEATH IN JAMAICA (2012) 5

6 JAMAICA HEALTH AND LIFESTYLE SURVEY Wilks et al Cross-sectional, interviewer-administered survey Questionnaire Demographics Chronic disease prevalence Health-seeking behaviour Reproductive health Socioeconomic status Lifestyle and health JAMAICA HEALTH AND LIFESTYLE SURVEY Documentation of blood pressure blood sugar cholesterol 2848 individuals between ages

7 JAMAICA HEALTH AND LIFESTYLE SURVEY Prevalence of chronic diseases was increased (compared to the 2001 survey) Obesity 25% Hypertension 25% Diabetes mellitus 8% High cholesterol 12% JAMAICA HEALTH AND LIFESTYLE SURVEY The majority (79.2%) of males reported that they have never had a rectal examination The proportion of men who had digital rectal examinations (DREs) in the past two years increased sharply at age 45 years (25%) Wilks et al. Jamaica Health and Lifestyle survey

8 JAMAICA HEALTH AND LIFESTYLE SURVEY Diet No special diet 30% reported frying was the preferred method of protein(fish and chicken) preparation 74% used vegetable oil for cooking 25% used fats(margarine/ butter) on bread 99% had below the daily intake of fruits and vegetables Wilks et al. Jamaica Health and Lifestyle survey HEALTH CARE FINANCING Large public and a large private health sector The public health sector is funded largely by taxes User fees were abolished in 2004 to all public health care facilities Large out-of-pocket payment are required as well Wilks et al. Jamaica Health and Lifestyle survey

9 HEALTH CARE FINANCING Nineteen percent of Jamaicans have private health insurance Men were more likely to have the benefit than women (M 22.4%, F 15.8%, p<0.01) Jamaican men have poor health seeking behaviour Men with private health insurance were more likely to seek health care Wilks et al. Jamaica Health and Lifestyle survey JAMAICA HEALTH EXPENDITURE 9

10 HEALTH CARE FINANCING The National Health Fund (NHF) was established in 2003 to provide substantial discounts for the most common diseases Medication for the treatment of prostate cancer was also included in 2005 COST OF MEDICATIONS 10

11 COST OF MEDICATIONS All biopsy proven high risk prostate cancer patients who were offered ADT from Proportion of patients choosing surgical castration versus medical castration giving the subsidy from the NHF in

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16 PROSTATE CANCER IN JAMAICA Leading local cause of male cancer 78.1/100,000 Leading cause of cancer mortality 53.9/100,000 Gibson et al, WIMJ

17 JAMAICA PROSTATE CANCER TRENDS Glover et al Incidence rates Included 1,121 cases of prostate cancer diagnosed Double data entry system Incidence of prostate 304/100,00 men This was not brought out in later studies 17

18 LOCAL DATA LOCAL DATA

19 INCIDENCE & MORTALITY RATES IN THE USA Jamaica SEER database Globocan

20 DEATH RATES Jamaica Globocan 2012 PROBLEM Prostate cancer is a major health issue Major part of the work load in the Urology Departments Prostate cancer is potentially curable when detected early Anecdotally, Kingston Public Hospital (KPH) more patients with advanced disease and those with higher risk parameters at presentation are seen There is very little data on disease profile Disease patterns likely to reflect those in the general population 20

21 JAMAICA S MAIN UROLOGY CENTERS KPH OVERVIEW Estimated that KPH Urology department is catchment for 60% of population In 2013 >1100 men presented for épsa or LUTS 47% of new attendees 386 TRUS biopsies in

22 ACKNOWLEDGEMENTS Dr. Michael Brooks- Consultant Urologist, KPH Prof. Marvin Reid Prof. TMRU Nurse Keisha Williams UOPD Head Nurse Mr. Oscar Slater Medical Clerk Dr. Jeremy Thomas - Urology Senior Resident Dr. Kayon Warren Urology Resident Dr. Claudia Walter - Urology Senior Resident Dr. Davon Mitchell - Urology Senior Resident AIMS & OBJECTIVES Document detection rate of prostate cancer at KPH & compare to international Document disease patterns: Age PSA Mode of presentation i.e. elevated PSA only versus Symptomatic presentation Histological findings - grade, tumor volume Determine proportion of patients amenable to curative treatment Possible risk factors 22

23 METHODS Retrospective review Study period: Jan 1, 2013 June 30, 2014 All prostate biopsies done at KPH in the period booking and appointment records Files obtained and data extracted re: Age PSA Symptoms Co-morbidities Use of 5-ARIs Clinical stage Histo-pathological findings - grade, tumor volume Treatment Approval from the ethics board METHODS Medical records were coded and information entered into a computerized data sheet Patients were risk stratified Early Locally Advanced Metastatic Analysis was done at the epidemiology unit 23

24 PROSTATE BIOPSY Ultrasound guided only All 12 core biopsies Done by Residents (mostly) Medical officers Consultants/ Attendings PROSTATE BIOPSY Samples were sent in formaldehyde to the lab- National Public Health Lab There is no specialized genito-urinary pathologist Any of the general pathologists will review the slides 24

25 FINDINGS Jan 2013-Dec biopsies Jan 2014-June biopsies Total of patients had missing data 409 patients data were available for assessment Of these - 17 had no histology recorded and were excluded 392 files were suitable for inclusion in the study FINDINGS Total 392 patients Average age: 69.4years Range

26 FINDINGS Mean age at cancer diagnosis 70.3years Range PSA range ng/ml Mean PSA at cancer diagnosis 94.3 ng/ml DISTRIBUTION BY PARISH

27 SYMPTOMS/DRE AT PRESENTATION % 80.00% 60.00% 40.00% 20.00% 0.00% 84.18% 81.90% LUTS All patients 64.20% 50.38% AbN DRE Cancer 24 (13.6%) of patients presented with symptoms suggestive of metastatic disease BIOPSY DETECTION RATES N = , 45% 186, 47% Benign ASAP PIN Cancer 4, 1% 26, 7% 27

28 CLINICAL (LOCAL) STAGE AT DX N = , 19% 80, 49% 53, 32% T1 T2 T3&T4 PSA DISTRIBUTION outcome PSA value group < >100 Benign ASAP PIN Cancer (56.25%) of cancer patients had PSA > 20ng/ml P <

29 HISTOLOGY OUTCOMES BY PSA outcome N Mean PSA min max Benign ASAP PIN Cancer Total GLEASON SCORES 60 N= N= GS 3+3 GS 3+4 GS 4+3 GS 8 29

30 RISK CATEGORY Low 10.2% Intermediate 24.5% High 65.3% 0 Low Intermediate High Risk categories DISTRIBUTION BY STAGE EARLY VS LOCALLY ADVANCED VS METASTATIC 95 Staging categories Early 53.9% LA 19.9% Mets- 26.1% Early Locally Advanced Metastatic 30

31 DISEASE IN SCREENED AND SYMPTOMATIC PATIETS Screened Unscreened Average PSA 17.69ng/ml ng/ml High Risk 25% 76.4% LA/Mets 9.4% 48.6% Only 15.8% of patients presented for a screening PSA COMPARISON Standard detection rates vary 28 40% 45% in our series 26% of men in USA have high risk disease 65.3% in this series 90% 0f newly diagnosed are organ confined 53.9% in our series National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines(r)): Prostate Cancer Early Detection. Version [May 1, 2012]; Meng MV et (CaPSURE). The Journal of urology May; 173(5): [PubMed: ] 31

32 FAMILY HISTORY Not stated 71 13/105 with positive FHx 12.4% 5/13 HG disease 38.4% Avg age 67.9yrs Average PSA = 94.5 CANCER DETECTION BY 5-ARI USE No. cancers Detection rate % Total No 5-ARI ARI

33 CANCER DETECTION BY 5-ARI USE Total (392) 28 Cancer(176) ARIs No ARIs HIGH-GRADE DISEASE BY ARI USE No ARI 5-ARI Total No. of Cancers No. of HG cancers % of HG cancers P >0.1 33

34 SCREENING Jamaica Urological Society Advocate screening in our population Men 40 years old Annual PSA and DRE Jamaica Cancer Society Weekly screening clinic CANCER TREATMENT OPTIONS No. % RRP Radiotherapy AS WW ADT alone Unsure

35 CONCLUSION In Jamaica, prostate cancer is a disease of the aging population Detection rates are high Jamaica has a high incidence of high-risk and advanced disease We advocate screening, however only a few men present as a result of screening Minority of cancers detected amenable to cure THANK YOU Dr. Ryan Paterson Dr. Alan So 35

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