Prostate cancer (CaP) disparities in the black man calls for concerted research efforts. This review explores the trend and focus of CaP research activities in Nigeria, one of the ancestral nations for black men. It seeks to locate the place of the Nigerian research environment in the global progress on CaP disparities. Literature was reviewed mainly through a Pubmed search with the terms “prostate cancer”and “Nigeria”, as well as from internet and hard copies of journal pages

AA Abioye

AA Ajape

AK Eziyi

AS Anjorin

Ayodeji O Olutunde

AZ Mohammed

BO Iko

CE Ejike

Chidiebere N Ogo

CU Igwe

D Dawam

DM Parkin

DN Osegbe

EA Afolayan

EE Akang

EO Nkposong

EO Olapade-Olaopa

F Ukoli

FA Ukoli

FF Angwafo

FM Abbiyesuku

FN Udeh

FT Odedina

J Ferlay

JO Ogunbiyi

K Dakum

KT Yawe

NB Delongchamps

NB Kumar

O Oladimeji

OB Shittu

PD Ekwere

TA Badmus

Titilola O Akinremi

VL Freeman

WI Onuigbo

Infectious Agents and Cancer

English

PubMed

Springer - Publisher Connector

Review of prostate cancer research in Nigeria

PROCEEDINGS Open Access
Review of prostate cancer research in Nigeria
Titilola O Akinremi1*, Chidiebere N Ogo2, Ayodeji O Olutunde1
From The Science of Global Prostate Cancer Disparities in Black Men
Jacksonville, FL, USA. 27-29 August 2010
Abstract
Prostate cancer (CaP) disparities in the black man calls for concerted research efforts. This review explores the trend
and focus of CaP research activities in Nigeria, one of the ancestral nations for black men. It seeks to locate the
place of the Nigerian research environment in the global progress on CaP disparities. Literature was reviewed
mainly through a Pubmed search with the terms “prostate cancer”and “Nigeria”, as well as from internet and hard
copies of journal pages.
Findings: One of the earliest publications about CaP in Nigeria was in 1973 from the nation’s 1st tertiary hospital in
Ibadan, reporting low incidence, followed by a lull of nearly one decade. In 1980, the incidence rate of CaP was
reported as almost similar for black men in Ibadan and Washington and from then on, research work from
surgeons and pathologists, from the south to the north, east to west, continued to report increasing prevalence of
CaP. Apart from epidemiology, other areas of research include KAP (knowledge attitude and practice) studies (poor
education of caregivers and population), histopathology (mostly adenocarcinoma), diagnosis (digital rectal
examination [DRE], prostate specific antigen [PSA], ultrasound), clinical features (late presentation and high
mortality), and prevention (lifestyle, education and screening). As of today there is a gaping dearth of molecular
and genetic studies. Conclusion: The global focus on CaP disparities in black men calls for more efforts from Africa,
in all areas of research, along with international collaborations for capacity building.
Background
Prostate Cancer has become the number one cancer in
men with increasing incidence and morbidity in men of
black African ancestry [1]. Its incidence and prevalence
in black men is in multiples of those from other races
in several studies [2]. The reason for this is not yet clear
cut and an explanation for the disparity may lie in stu-
dies involving black men from different populations to
see if there is an enhancing factor associated with the
racial origins of these men. Nigeria is an ancestral home
of many black men living outside Africa and it is hoped
that an exploration of research activities emanating
from the country may shed some light on the disparity
[3]. Odedina et al [4] recommend the need to focus on
areas of genetic and environmental risk factors in the
group.
Methods
Research studies emanating from Nigeria or involving
Nigerian subjects in relation to CaP were sourced using
the U.S. National Library of Medicine literature search
engine, PubMed [5], using the search terms “prostate
cancer” and “Nigeria”. Other sources included journal
websites and hard copies of journal articles. These gave
reports on CaP from all regions of the country, covering
topics including epidemiology, clinical presentation,
diagnosis, treatment and prevention.
Findings
Epidemiology
In 1973, Nkposong and Lawani[6], urologists from the
University College Hospital, Ibadan, South West Nigeria,
at the time the only referral center for cancer treatment,
noted a low but increasing incidence of prostate cancer.
It moved from 8th position of male cancers in 1969 to
2nd place by 1979, with liver cancer leading the pack [7].
In 1981, Udeh [8] also reported the same position from
Enugu, but up till 2002, Globocan [9] reported that CaP
* Correspondence: bakinremi2@aol.com
1Department of Pathology, Federal Medical Centre, Abeokuta, Nigeria
Full list of author information is available at the end of the article
Akinremi et al. Infectious Agents and Cancer 2011, 6(Suppl 2):S8
http://www.infectagentscancer.com/content/6/S2/S8
© 2011 Akinremi et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
was not among the top 5 cancers in developing
countries.
Angwafo [10], while reporting 93.8/105 incidence from
Cameroon in 1994, asked the question “Is prostate can-
cer rare in black Africa?” while Osegbe [11] in a report
from Lagos where the hospital incidence was put at
127/105, surmised that incidence of CaP may be under-
estimated in Nigerians. Similar reports of increasing
hospital based incidence came from other parts of
Nigeria with rates of 61.3/105 from Calabar [12] and
182.5/105 from Ife [13]. The stance of Globocan has
since changed with the 2008[14] report that CaP had
become the top male cancer and fourth commonest
cancer in Nigeria.
Ogunbiyi and Shittu [15] from the Ibadan Cancer Reg-
istry in 1999 announced a definite increase of CaP
among Nigerians. It had risen from 8th position in 1969
to 1st position in 1996, being 11% of all male cancers.
Studies from Kano [16], Zaria [17], Benin [18] and Mai-
duguri [19] showed CaP as16.5%, 9.2%, 7.13% and 6.15%
of male cancers.
Clinical presentation
Reports from all regions of the country emphasize late
presentation as the pattern in Nigerian CaP patients.
From both South [12] and North [19] about two thirds of
patients presented with metastatic disease, and 94.2%
[13] and 91% [20] presented with complications respec-
tively. Mortality was generally high with 64% dead within
2 years in a review by Osegbe [11]. Metastases were typi-
cally to the spine, with attendant paraparesis or paraple-
gia, and rare orbital metastases were reported from
Ibadan [21].
Diagnosis
There is growing concern that medical students are not
gaining enough skills in DRE [22], such that clinical diag-
nosis of CaP may become a dilemma for the younger
generation of doctors. Though final year students at the
University of Jos have adequate teaching, right attitude,
perspective, and knowledge about examining for prostate
cancer, they have not translated the same into practice
and 86% had never felt a malignant prostate while 45%
had never examined the gland [23].
Iko [24] in 1987 suggested that prostatic ultrasonogra-
phy may have great diagnostic promise in developing
economies where more sophisticated equipments may
be uncommon. However, Ajape [25] in a more recent
report(2010) noted 50% sensitivity and false negative
correlation between ultrasound and CaP diagnosis.
Histopathology
Studies from all regions of the country found that ade-
nocarcinoma is the predominant histologic type, similar
to global findings. CaP constitutes a moderate portion
of biopsies of the prostate. Studies from Benin [18],
Ilorin [26] , and Kano [16] also reported malignancy
rates of 17%, 16.9% and 22.4% respectively. Freeman et
al [27] compared the Gleason system interpretation
between genitourinary pathologists in Nigeria, Jamaica
and US and concluded that the revealed concordance
makes international studies using this grading system
feasible.
PSA
Although (PSA) is a controversial instrument for screen-
ing, it remains a useful parameter for monitoring treat-
ment. The distribution of PSA in a rural Nigerian
population was found to be similar to that of unscreened
US populations with greater than 4ug/l readings in 14%
of men [28], and Igwe [29] found that 85.1% prostate
cancer patients had total PSA above the normal cut off
level. The median total PSA in CaP was found to be
92.6ug/l and 106ug/l respectively in Ibadan [30] and Ife
[12].
Prevention
There is not yet any national cancer screening program
and annual PSA checks are not practiced routinely in
Nigeria. Lifestyle and behavioral patterns are known to be
important in cancer prevention but education about CaP
is sparse in Nigeria and opportunistic. Ajape et al [31]
concluded that “there is remarkable lack of awareness of
prostate cancer among the Nigerian urban populace. Pros-
tate cancer screening and serum PSA test for screening is
globally unknown among them”. Though knowledge and
risk perception of prostate cancer were low, Oladimeji et
al [32] found that 81.5% were willing to be screened for
the disease. Odedina et al [33] suggested that emigration
of Nigerian men from Nigeria to the US has a significant
impact on prostate cancer knowledge and beliefs. Compar-
ing indigenous and immigrant Nigerian men’s diet, alcohol
consumption, tobacco use and physical activities, Kumar
et al [34] found that there were enough differences to pro-
voke deeper search. Meanwhile, reporting from Nsukka ,
Ejike and Ezeanyiwa [35] suggested that lifestyle changes
in Nigerian men leading to westernized diet and use of
energy sparing devices (status symbols) may lead to
increase in incidence of chronic diseases like cancer. A
trend towards high total plasma omega-6 was observed
and found to have a moderate positive correlation with
prostate cancer in Nigerians [36].
Treatment
Since most patients present with poor prognostic fea-
tures including high histological grades and clinical
stages, treatment is mostly palliative with bilateral orchi-
dectomy with or without anti androgen therapy [37].
Akinremi et al. Infectious Agents and Cancer 2011, 6(Suppl 2):S8
http://www.infectagentscancer.com/content/6/S2/S8
Page 2 of 4
A discomforting finding in Ilorin showed that only
38.9% of patients had histopathological diagnosis before
treatment[25]. No clinical trials were reported.
Conclusion
Prostate cancer research in Nigeria is growing and multifa-
ceted. There is a need to collate figures into the National
Cancer Registry. Education and knowledge about prostate
cancer is sparse, and even medical students need better
training in digital rectal examination. Patients often pre-
sent late with complications, pathological diagnosis is
mostly of adenocarcinona, resulting commonly in pallia-
tive orchiectomy. Routine screening is not practiced and
most PSA testing and digital rectal examination emanate
from surgical clinics. The disparity in prostate cancer pre-
valence and mortality in the black man calls for concerted
efforts from all and sundry to include all areas of research.
Nigerian researchers stand at a vantage position to carry
out local work as well as collaborate with other stake-
holders all over the world.
Acknowledgements
This article has been published as part of Infectious Agents and Cancer
Volume 6 Supplement 2, 2011: Proceedings of the First Biennial Conference
on the Science of Global Prostate Cancer Disparities in Black Men. The full
contents of the supplement are available online at http://www.
infectagentscancer.com/supplements/6/S2.
Author details
1Department of Pathology, Federal Medical Centre, Abeokuta, Nigeria.
2Department of Urology, Federal Medical Centre, Abeokuta, Nigeria.
Competing interests
The authors declare that they have no competing interests.
Published: 23 September 2011
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doi:10.1186/1750-9378-6-S2-S8
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Abiola OO: An overview of cancer of the prostate diagnosis and management in Nigeria: The experience in a Nigerian tertiary hospital.

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Edino ST, Ochicha O: Histopathological review of prostatic diseases in

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Kidmas AT: Digital rectal examination for prostate cancer: attitude and experience of final year medical students. Niger J Clin Pract

Lifestyle changes in Nsukka Metropolis in relation to prostate cancer and benign prostate hyperplasia.

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Prostate cancer disparities in Black men of African descent: a comparative literature review of prostate cancer burden among Black men in the United States, Caribbean, United Kingdom, and West Africa. Infect Agent Cancer 2009, 10(4 Suppl 1):S2.

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Review of prostate cancer research in Nigeria

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