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

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous