title: Early results of prostate cancer radiation therapy: an analysis with emphasis on research strategies to improve treatment delivery and outcomes.
abstract: BACKGROUND
  There is scant data regarding disease presentation and treatment response among black men living in Africa. In this study we evaluate disease presentation and early clinical outcomes among Ghanaian men with prostate cancer treated with external beam radiotherapy (EBRT).
  
  
  METHODS
  A total of 379 men with prostate cancer were referred to the National Center for Radiotherapy, Ghana from 2003 to 2009. Data were collected regarding patient-and tumor-related factors such as age, prostate specific antigen (PSA), Gleason score (GS), clinical stage (T), and use of androgen deprivation therapy (ADT). For patients who received EBRT, freedom from biochemical failure (FFbF) was evaluated using the Kaplan-Meier method.
  
  
  RESULTS
  Of 379 patients referred for treatment 69.6% had initial PSA (iPSA) > 20 ng/ml, and median iPSA was 39.0 ng/ml. A total of 128 men, representing 33.8% of the overall cohort, were diagnosed with metastatic disease at time of referral. Among patients with at least 2 years of follow-up after EBRT treatment (n=52; median follow-up time: 38.9 months), 3- and 5-year actuarial FFbF was 73.8% and 65.1% respectively. There was significant association between higher iPSA and GS (8-10 vs. ≤7, p < 0.001), and T stage (T3/4 vs. T1/2, p < 0.001).
  
  
  CONCLUSIONS
  This is the largest series reporting on outcomes after prostate cancer treatment in West Africa. That one-third of patients presented with metastatic disease suggests potential need for earlier detection to permit curative-intent therapy. Data from this study will aid in the strategic development of prostate cancer research roadmap in Ghana.
authors: Department of Radiation Oncology, Kimmel Cancer Center & Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA. jkosjc@gmail.com
authors: Kosj
authors: K
authors: Yamoah
authors: Kwamena
authors: K
authors: Beecham
authors: Sarah E
authors: SE
authors: Hegarty
authors: Terry
authors: T
authors: Hyslop
authors: Timothy
authors: T
authors: Showalter
authors: Joel
authors: J
authors: Yarney
mesh_terms: D000367:Age Factors; D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D044383:Black People; D001918:Brachytherapy; D019583:Dose Fractionation, Radiation; D005869:Ghana; D006801:Humans; D007610:Kallikreins / Q000097:blood; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009919:Orchiectomy; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D011880:Radiotherapy Planning, Computer-Assisted; D011881:Radiotherapy, Computer-Assisted; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen