Defining national research priorities for prostate cancer in Zambia: using the Delphi process for comprehensive cancer policy setting in sub-Saharan Africa

Objectives Locally led research on cancer is needed in sub-Saharan Africa to set feasible research priorities that inform national policy. The aim of this project was to develop a research agenda for national cancer control planning, using a nationally driven approach, focused on barriers to diagnosis and high-quality treatment for prostate cancer in Zambia. Methods and analysis This was a Delphi process. 29 stakeholders were scored barriers on feasibility, the proportion of patients affected, the impact on patient outcomes and if there was a potential to address health systems barriers meaningfully. There were three rounds (R) to the process: (R1 and R2) by electronic survey and (R3) in-person meeting. In R1 statements scoring above 15 from over 70% of participants were prioritised immediately for R3 discussion. Those scoring below 30% were dropped and those in between were re-surveyed in R2. Results 22 and 17 of the 29 stakeholders responded to R1 and R2. 14 stakeholders attended R3. National priority research areas for prostate cancer in Zambia were identified as prostate cancer awareness; building affordable high-quality diagnostic capacity; affordability of specialist cancer treatments; supporting better access to medicines; delivery and coordination of services across the pathway and staff training. Conclusion The suggested seven priority areas allow for the development of the prostate cancer control programme to be conducted in a holistic manner. The expectation is with this guidance international partners can contribute within the frameworks of the local agenda for sustainable development to be realised

Factors associated with response to Androgen Deprivation Therapy in patients with Metastatic Prostate Cancer at the University Teaching Hospital Lusaka, Zambia

Background: Prostate cancer in most cases is dependent on the presence of androgens (testosterone) produced either by the testis or adrenal gland. The major risk factors for development include aging, ethnicity and genetic predisposition. Organ confined prostate cancer iscurable by surgery or radiotherapy while metastatic disease is treated by androgen deprivation therapy (ADT). ADT can be achieved medically(gonadotropin releasing hormone agonists or antagonists) or surgically (bilateral orchiectomy). A decrease in serum prostate specific antigen (PSA) is used as a marker of response to ADT. Metastatic prostate cancer has been found to be the most common cause of death in the urology  department at the University Teaching Hospitals – Adult Hospital even after ADT, therefore, the aim of this study was to identify the pre-treatment factors that can be used to determine the response to ADT.Methodology: This was a cross section study conducted at the University Teaching Hospitals- Adult Hospital and Cancer Diseases Hospital. It wascarried out between December 2017 and September 2018. Patients with metastatic prostate cancer were recruited. Socio-demographic  characteristics, clinical presentation and histopathological findings were elicited by detailed history and file review. PSA and Eastern Cooperative Oncology Group (ECOG) performance status score were obtained prior to ADT commencement. ADT was done and patients were scheduled for a three month post ADT review where PSA and ECOG performance status score were reobtained.Results: 50 patients were recruited into the study. The total patient retention was 88% (n=44). The average age was 71. Majority, 89% (n=39) had some level of education; 98% (n=43) had lower urinary tract symptoms (LUTS); 11% (n=5) had paraplegia. 98% (n=43) had bone metastasis. Duration of symptoms at presentation was > 6 months in 75%(n=33) patients. ECOG score was above 1 in 75% (n=33). Initial PSA was above 100ng/ml in 75%(n=38). All patients had Gleason scores above 7. All patients had a drop in PSA after ADT. The average PSA percentage drop in men below 60 years was 80.5% whereas the average percentage drop in PSA with regards to other factors was 91.19%.Conclusion: All patients had androgen dependant cancers. These patients also had high risk prostate cancer with initial PSA values above 100ng/ml and Gleason scores above 7. Of all the factors analysed, age below 60 years was found to be the only clinically significant factor associated with poorresponse to ADT

A Cross Sectional Study of the Prevalence of Preputial and Penile Scrotal Abnormalities among Clients Undergoing Voluntary Medical Male Circumcision in Soweto, South Africa.

Medical device use is currently approved for males without preputial or major penile scrotal abnormalities for voluntary medical male circumcision (VMMC). We determined the prevalence of preputial abnormalities at a busy VMMC centre in Soweto, South Africa.This was a cross-sectional record review at a high-volume VMMC centre in South Africa. We collated pre-circumcision demographic and genital examination findings from clients 8 years and older who had undergone VMMC from 01 May 2013 to 30 April 2014. Logistic regression was used to determine factors associated with preputial abnormalities.During the review period, 6861 circumcisions were conducted and 37.1% (n = 2543) were 8-13 year olds. Median age was 15 years (IQR: 12-23 years). Fifteen percent (n = 1030) had preputial abnormalities or major penile scrotal abnormalities. Age-specific prevalence of preputial or major genital abnormalities were 27.3%, 10.6% and 6.0% in 8-13, 14-18 and > 18 year olds respectively. The odds of preputial or major penile scrotal abnormality were higher in younger clients aged 8-13 years (OR = 5.9; 95% CI = 4.8-7.1) and 14-18 years (OR = 1.9; 95% CI = 1.5-2.4) compared to older clients above18 years and in those testing for HIV outside our clinic network (OR = 1.9; 95% CI = 1.4-2.7).The high prevalence of preputial and penile scrotal abnormalities observed suggests a need for VMMC sites to provide for both open surgical and devices methods in the provision of VMMC services. This is especially so among young male subjects presenting themselves for VMMC services at the various sites being developed in sub Saharan African countries

Characteristics of clients who presented for VMMC by age in Soweto.

<p>Characteristics of clients who presented for VMMC by age in Soweto.</p

Factors associated with genital abnormality in Soweto.

<p>Factors associated with genital abnormality in Soweto.</p

Overall distribution of genital abnormalities.

<p>Overall distribution of genital abnormalities.</p

Distribution of complete coronal adhesions by age.

<p>Distribution of complete coronal adhesions by age.</p