Management of advanced prostate cancer in Africa.
BACKGROUND
Carcinoma of the prostate (CaP) is the most common male malignancy in developed and developing countries and has been termed the "malignant epidemic of blacks." Despite this, clinicians managing men with advanced CaP in Africa have to contend with significant limitations in the healthcare systems. This article reviews the current and future options for the management of these patients on the African continent.


METHODS
We searched PubMed and Google for articles on CaP with an emphasis on those focusing on subpopulation differences. Information was also obtained from ongoing studies and interviews with urologists and other specialists and executives in hospitals in our locality.


RESULTS
In Africa, most patients with CaP present with advanced disease, and surgical castration is the most common treatment option, as most modern treatment strategies for the disease are unavailable or unaffordable. Unfortunately, a significant proportion of these men progress to hormone-resistant disease shortly after first-line hormonal treatment, and a majority die within 2 years. Problems that are peculiar to the African continent include poor health facilities, scarcity of expert care, high cost of treatment, lack of data, low level of awareness of the disease, absence of early detection and treatment programs, cultural limitations, and the prominence of alternative medical practice.


CONCLUSIONS
Most Africans with CaP present with advanced disease, and treatment is mostly limited to bilateral orchiectomy, but the results are poor. The care of these patients can be improved by increased funding of healthcare institutions and projects directed at prevention, early detection, and treatment.
Olapade-Olaopa
E Oluwabunmi
EO
Department Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Obamuyide
H Adebayo
HA
Yisa
Gloria T
GT
D000349:Africa; D002277:Carcinoma / Q000601:surgery / Q000628:therapy; D005102:Health Expenditures / Q000592:standards; D006296:Health Services / Q000592:standards; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000601:surgery / Q000628:therapy*