Management of Clinically Localised Prostate Cancer: Guideline Concordance and Clinical Outcomes from Tertiary Institutions in Nigeria

Abstract

BACKGROUND: Patients with clinically localised prostate cancer (CaP) have a potentially curable disease. However, there are gaps in the quality of care these patients receive in Nigeria. Granular clinical data are needed to design interventions for quality improvement. AIMS: This study aimed to describe guideline concordance of cancer management and its association with patient outcomes. SUBJECTS AND METHODS: A 3-year retrospective study of all patients with T1-T3a, N0, M0 CaP at three tertiary hospitals in Nigeria was conducted. Data on clinicopathologic characteristics, D'Ámico risk group, TNM staging, treatment practices, post-treatment PSA and survival were collected. Concordance with the 2022 European Association of Urology guideline was assessed. Primary endpoints were guideline concordance of staging and treatment, and associations between concordance and outcomes. RESULTS: This study included 110 patients with mean age of 68 years. Sixty-seven patients (60.9%) were high-risk, 34 (30.9%) were intermediate-risk and 9 (82%) were low-risk. Most patients were staged with abdominopelvic ultrasound (65%, n = 71). Guideline-concordant magnetic resonance imaging for T-staging was significantly higher in low-risk (44%, n = 4) than in high-risk (12%, n = 8) patients (P = 0.041). Guideline-concordant axial imaging for N and M staging was used in 11% (n = 7) of high-risk patients. In the overall cohort, 17 patients (15%) received guideline-concordant definitive treatment with either radical prostatectomy (n = 8; 9%) or radiotherapy (n = 9; 5%), whereas 52 patients (56%) received non-concordant androgen deprivation therapy (ADT) alone and 43 received no treatment. Median time to biochemical recurrence was not significantly different between those who received surgery (18 months), radiation therapy (median not obtained) or ADT alone (11 months) (log-rank P = 0.103). After a median follow-up of 36 months, median overall survival was similar for guideline-concordant and non-concordant treatment groups (37 and 34 months, respectively; log-rank P = 0.540). CONCLUSION: CaP staging was suboptimal across all risk groups. Only a minority of patients received radical treatment for this potentially curable disease. Our results will inform the development of tailored multifaceted interventions to improve the quality of care.