Comparison of changes in serum prostate specific antigen in prostate cancer patients treated either with flutamide or stilboestrol monotherapy

Prostate cancer is a disease of males. Though commoner in the elderly, cases are beginning to be reported in the younger population. It is thecommonest cancer diagnosed in males. Risk factors include ageing, genetic/familial factors, racial predilection, increased fat diet, and hormonal imbalance. It is a slow-growing tumour but can be associated with severe morbidity. The commonest histologic type is adenocarcinoma (>95%). When detected early, cure may be possible. Prostate-specific antigen (PSA) is the major serum marker used to monitor progress of the disease and its' response to therapy. Several treatment modalities have been used in the management of prostate cancer. This includes watchful waiting, prostatectomy, radiotherapy, hormone therapy, and chemotherapy. These treatment options are not without devastating and sometimes life-threatening adverse effects; hence the choice of therapy depends on patient's age, stage of disease, other co-morbidities, and even patient's choice.Aims and Objectives: This study aimed at establishing the variation in PSA among patients with advanced CaP treated either with Flutamideor Stilboestrol monotherapy in UCTH, Calabar. This helped in choosing an agent with better patient compliance, better therapeutic effect, minimal side-effects, and cost-effectiveness.Method: All newly diagnosed prostate cancer patients in the Division of Urology, Department of Surgery, UCTH, Calabar that met certain inclusion criteria were treated either with Flutamide or Stilboestrol monotherapy over a period of one year. Patients enrolled into the study were shared into two equal groups based on certain considerations. Response to therapy was monitored by conducting a three-monthly PSA check and results from the groups compared.Results: Fifty patients were enrolled into the study. The mean age was 70.12±8.93, and age range was 51-93 years. The peak age range was 61-70 years constituting 40.0% of total number of patients. The decline in serum PSA caused by flutamide and stilboestrol during each quarter of the year was 8.0%, 12.0%, 12.0%, 4.0% and 28.0%, 4.0%, 28.0%, 4.0% respectively. Overall flutamide caused a 36.0% reduction and stilboestrol 64.0% reduction in serum PSA over the period. In all, stilboestrol caused a greater decline in serum PSA compared to flutamide, and this became statistically significant at 9 months (p=0.044) and one year (p=0.048) of therapy.Conclusion: Patients who are on androgen deprivation therapy for CaP have their serum PSA reduced by either flutamide or stilboestrol monotherapy. However, over time, the PSA is more rapidly reduced by stilboestrol monotherapy compared to flutamide monotherapy. Keywords: Prostate Cancer, Flutamide, Stilboestrol, PSA

Overcoming Barriers in Conducting a Transatlantic Prostate Cancer Familial Study in Africa: Best Practice from the CaPTC Cohort Study

Conducting prostate cancer research, especially prospective data collection in Africa, has numerous challenges. Some of the difficulties stem from socio-cultural factors that consider sensitive topics about men’s health as taboo. Our primary aim was determine how to overcome barriers in conducting a transatlantic prostate cancer familial study in African males.Key research personnel of the CaPTC Transatlantic Prostate Cancer Familial Project were surveyed about their experiences in implementing the study. The data from the survey was analyzed using SPSS version 18. A total of 15 key study personnel responded to the survey. About 73% of the respondents reported that the participants requested a home or office visit rather than visit a data collection center. Eighty percent (80%) of the respondents reported that the participants had no preference for interviewer gender. The majority (80%) of the interviewers agreed that answers to questions about participants’ sexuality were most challenging to obtain, but with an in-depth explanation of the importance of the study and assurance of privacy, the answers were obtained. The best practice for engaging the community for research include community mobilization through sensitization visits and one-on-one talks, use of community ‘gatekeepers’, introduction by relatives, assurance of privacy of health data obtained, the use of incentives and a promise to give feedback on the results of the study both on a personal and community level