CC BY-NC-ND 4.0 · Avicenna J Med 2020; 10(03): 93-101
DOI: 10.4103/AJM.AJM_19_20
Review Article

High mortality risk of prostate cancer patients in Asia and West Africa: A systematic review

Jude O Okoye
Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, College of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
› Author Affiliations

Subject Editor: Financial support and sponsorship Nil.


Globally, prostate cancer (PCa) is the second most preponderant cancer in men. It contributes to the high mortality-to-incidence ratio reported in West Africa and Asia largely due to low screening. The mortality risk is determined or predicted based on the prevalence of high-risk or aggressive PCa using a scoring or grading system such as Gleason score (GS), Gleason grade (GG), and prostate-specific antigen (PSA) level. In this review, peer-reviewed articles found on databases such as Google Scholar, Scopus, Web of Science, PubMed Central and, EMBASE were selected based on adherence to clinical guidelines for the classification of PCa. In West Africa and Asia, the result revealed that the frequency of high-risk PCa was 42% and 51.2% based on GS, 48.8% and 25.3% based on GG pattern, and 87.5% and 44.3% based on PSA level >10 ng/mL, respectively. Data revealed a high prevalence of high-risk PCa both in West Africa and Asia when compared with developed countries. However, the prevalence of high-risk PCa is higher in West Africa than in Asia. Studies have shown that high-risk PCas are associated with germline mutations and such mutations are prevalent in blacks and Asians than in whites. Thus, testing for germline mutations in patients with GS of ≥ 7, GG ≥ 3, high prostate density, low prostate volume, and PSA levels of >4.0 ng/mL may identify those at risk of developing lethal PCa and could reduce the mortality rates in Asia and West Africa.

Publication History

Article published online:
04 August 2021

© 2020. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

  • References

  • 1 Lakhtakia R, Bharadwaj R, Kumar VK, Mandal P, Nema SK. Immunophenotypic characterization of benign and malignant prostatic lesions. Med J Armed Forces India 2007; 63: 243-8
  • 2 Garg M, Kaur G, Malhotra V, Garg R. Histopathological spectrum of 364 prostatic specimens including immunohistochemistry with special reference to grey zone lesions. Prostate Int 2013; 1: 146-51
  • 3 Farooq S, Bilai S, Khaliq BI, Sidieq F, Aslam H, Shah I. The spectrum of histopathological patterns observed in prostate specimens in a tertiary care hospital in Kashmir. Int J Contemp Med Res 2019; 6: D1-3
  • 4 Fitzmaurice C, Akinyemiju TF, Al Lami FH, Alam T, Alizadeh-Navaei R, Allen C. et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016: A systematic analysis for the global burden of disease study. JAMA Oncol 2018; 4: 1553-68
  • 5 Small E. Cecil Textbook of Medicine, Prostate Cancer. Philadelphia: WB Saunders; 2004
  • 6 Mohler JL, Armstrong AJ, Bahnson RR, Boston B, Busby JE, D’Amico AV. et al. Prostate cancer, version 3.2012: Featured updates to the NCCN guidelines. J Natl Compr Canc Netw 2012; 10: 1081-7
  • 7 Epstein JI, Allsbrook Jr WC, Amin MB, Egevad LL. ISUP Grading Committee. The 2005 international society of urological pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 2005; 29: 1228-42
  • 8 Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87-108
  • 9 Chen SL, Wang SC, Ho CJ, Kao YL, Hsieh TY, Chen WJ. et al. Prostate cancer mortality-to-incidence ratios are associated with cancer care disparities in 35 countries. Sci Rep 2017; 7: 40003
  • 10 Donnelly DW, Gavin A, Downing A, Hounsome L, Kearney T, McNair E. et al. Regional variations in quality of survival among men with prostate cancer across the United Kingdom. Eur Urol 2019; 76: 228-37
  • 11 Chung BH, Horie S, Chiong E. Clinical studies investigating the use of leuprorelin for prostate cancer in Asia. Prostate Int 2020; 8: 1-9
  • 12 Culp MB, Soerjomataram I, Efstathiou JA, Bray F, Jemal A. Recent global patterns in prostate cancer incidence and mortality rates. Eur Urol 2020; 77: 38-52
  • 13 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424
  • 14 Taitt HE. Global trends and prostate cancer: A review of incidence, detection, and mortality as influenced by race, ethnicity, and geographic location. Am J Mens Health 2018; 12: 1807-23
  • 15 Chen R, Ren S, Yiu MK, Fai NC, Cheng WS, Ian LH. et al Chinese Prostate Cancer Consortium. Prostate cancer in Asia: A collaborative report. Asian J Urol 2014; 1: 15-29
  • 16 Baade PD, Youlden DR, Cramb SM, Dunn J, Gardiner RA. Epidemiology of prostate cancer in the Asia-Pacific region. Prostate Int 2013; 1: 47-58
  • 17 Henderson RJ, Eastham JA, Culkin DJ, Kattan MW, Whatley T, Mata J. et al. Prostate-specific antigen (PSA) and PSA density: Racial differences in men without prostate cancer. J Natl Cancer Inst 1997; 89: 134-8
  • 18 Hugosson J, Carlsson S, Aus G, Bergdahl S, Khatami A, Lodding P. et al. Mortality results from the göteborg randomised population-based prostate-cancer screening trial. Lancet Oncol 2010; 11: 725-32
  • 19 Carlsson S, Assel M, Ulmert D, Gerdtsson A, Hugosson J, Vickers A. et al. Screening for prostate cancer starting at age 50-54 years. A population-based cohort study. Eur Urol 2017; 71: 46-52
  • 20 Pashayan N, Pharoah P, Neal DE, Hamdy F, Donovan J, Martin RM. et al. Stage shift in PSA-detected prostate cancers––effect modification by Gleason score. J Med Screen 2009; 16: 98-101
  • 21 Garg V, Gu NY, Borrego ME, Raisch DW. A literature review of cost-effectiveness analyses of prostate-specific antigen test in prostate cancer screening. Expert Rev Pharmacoecon Outcomes Res 2013; 13: 327-42
  • 22 Awodele O, Adeyomoye AA, Awodele DF, Fayankinnu VB, Dolapo DC. Cancer distribution pattern in south-western Nigeria. Tanzan J Health Res 2011; 13: 125-31
  • 23 Imasogie DE, Azeke AT. Prostatic adenocarcinoma and prostatic intraepithelial neoplasia: A tale of the autopsy model in a Nigerian tertiary hospital. Niger J Surg Sci 2017; 27: 41-6
  • 24 Erhabor O, Zama I, Mainasara AS, Shehu RA, Iwueke IP, Festus A. et al. Prostate Specific Antigen (PSA) screening among apparently healthy men of African descent in Sokoto, North Western, Nigeria. Int Blood Res Rev 2014; 2: 37-47
  • 25 Akinremi T, Adeniyi A, Olutunde A, Oduniyi A, Ogo C. Need for and relevance of prostate cancer screening in Nigeria. Ecancermedicalscience 2014; 8: 457
  • 26 Ukoli F, Osime U, Akereyeni F, Okunzuwa O, Kittles R, Adams-Campbell L. Prevalence of elevated serum prostate-specific antigen in rural Nigeria. Int J Urol 2003; 10: 315-22
  • 27 Ikuerowo SO, Ajala MO, Abolarinwa AA, Omisanjo OA. Age-specific serum prostate specific antigen ranges among apparently healthy Nigerian men without clinical evidence of prostate cancer. Niger J Surg 2016; 22: 5-8
  • 28 Anunobi CC, Akinde OR, Elesha SO, Daramola AO, Tijani KH, Ojewola RW. Prostate diseases in Lagos, Nigeria: A histologic study with TPSA correlation. Niger Postgrad Med J 2011; 18: 98-104
  • 29 Nwafor CC, Keshinro OS, Abudu EK. A histological study of prostate lesions in Lagos, Nigeria: A private practice experience. Nig Med J 2015; 56: 338-43
  • 30 Ugwumba FO, Ozoemena OF, Okoh AD, Echetabu KN, Mbadiwe OM. Transvesical prostatectomy in the management of benign prostatic hyperplasia in a developing country. Niger J Clin Pract 2014; 17: 797-801
  • 31 Forae G, Obaseki DE, Aligbe JU, Ekanem VJ. Morphological patterns of prostatic lesions in Benin city, Nigeria: A twenty year retrospective study. Ann Trop Pathol 2011; 2: 23-8
  • 32 Dawam D, Rafindadi AH, Kalayi GD. Benign prostatic hyperplasia and prostate carcinoma in native Africans. BJU Int 2000; 85: 1074-7
  • 33 Emokpae MA, Das SC, Orok T, Mohammed AZ, Hassan SA. Early detection of prostate cancer: Evaluating the diagnostic performance of prostate specific antigen by comparing with histological technique among Africans. Indian J Clin Biochem 2004; 19: 62-6
  • 34 Obiorah CC, Ofuru V. A Population based study of prostate cancer in rivers state, Nigeria. Int J Biomed Sci 2019; 15: 57-62
  • 35 Isiwele EM, Bassey IAE, Ikpi EE, Enakirerhi GE, Otobo FO, Essiet A. et al. Histopathologic patterns of urological malignancies in Calabar, South-Southern Nigeria: A ten-year review. J Cancer Tumor Int 2018; 8: 1-10
  • 36 Bassey IA, Isiwele EM, Debua A. Prognostication studies of prostate cancer in black Africa: Findings from Calabar, South-South, Nigeria. Int J Cont Med Res 2018; 5: E1-5
  • 37 Abubakar M, Shehu SM, Ahmed SA, Liman AA, Akpobi KC, Mohammed A. et al. Adenocarcinoma of the prostate: Correlation between serum prostate-specific-antigen and Gleason grade group. Ann Trop Pathol 2018; 9: 126-30
  • 38 Agalliu I, Adebiyi AO, Lounsbury DW, Popoola O, Jinadu K, Amodu O. et al. The feasibility of epidemiological research on prostate cancer in African men in Ibadan, Nigeria. BMC Public Health 2015; 15: 425
  • 39 Oluwole OP, Rafindadi AH, SHehu MS, Samaila MOA. A ten-year stud of prostate cancer specimens at Ahmadu Bello University Teaching Hospital (A.B.U.T.H.), Zaria, Nigeria. Afr J Urol 2015; 21: 15-8
  • 40 Ikuerowo SO, Omisanjo OA, Bioku MJ, Ajala MO, Mordi VP, Esho JO. Prevalence and characteristics of prostate cancer among participants of a community-based screening in Nigeria using serum prostate specific antigen and digital rectal examination. Pan Afr Med J 2013; 15: 129
  • 41 Sapira MK, Obiorah CC. Age and pathology of prostate cancer in south-southern Nigeria; is there a pattern?. Med J Malaysia 2012; 67: 417-9
  • 42 Ajape AA, Ibrahim KO, Fakeye JA, Abiola OO. An overview of cancer of the prostate diagnosis and management in Nigeria: The experience in a Nigerian tertiary hospital. Ann Afr Med 2010; 9: 113-7
  • 43 Mohmmed AZ, Nwana EJC, Anjorin AS. Histopathological pattern of prostatic diseases in Nigerians. Afr J Urol 2005; 11: 33-8
  • 44 Aghaji AE, Odoemene CA. Prostatic cancer after prostatectomy for benign prostatic hyperplasia in Nigeria. East Afr Med J 2000; 77: 635-9
  • 45 Herget KA, Patel DP, Hanson HA, Sweeney C, Lowrance WT. Recent decline in prostate cancer incidence in the United States, by age, stage, and Gleason score. Cancer Med 2016; 5: 136-41
  • 46 Buie J, De Riese W, Sharma P. Smaller prostate volume is associated with adverse pathological features and biochemical recurrence after radical prostatectomy. Urol Sci 2019; 30: 255-61
  • 47 Jedinak A, Curatolo A, Zurakowski D, Dillon S, Bhasin MK, Libermann TA. et al. Novel non-invasive biomarkers that distinguish between benign prostate hyperplasia and prostate cancer. BMC Cancer 2015; 15: 259
  • 48 Page EC, Bancroft EK, Brook MN, Assel M, Hassan Al Battat M, Thomas S. et al IMPACT Study Collaborators. Interim results from the IMPACT study: Evidence for prostate-specific antigen screening in BRCA2 mutation carriers. Eur Urol 2019; 76: 831-42
  • 49 Leongamornlert DA, Saunders EJ, Wakerell S, Whitmore I, Dadaev T, Cieza-Borrella C. et al. Germline DNA repair gene mutations in young-onset prostate cancer cases in the UK: Evidence for a more extensive genetic panel. Eur Urol 2019; 76: 329-37
  • 50 Nyberg T, Frost D, Barrowdale D, Evans DG, Bancroft E, Adlard J. et al. Prostate cancer risks for male BRCA1 and BRCA2 mutation carriers: A prospective cohort study. Eur Urol 2020; 77: 24-35
  • 51 Horn T, Krönke M, Rauscher I, Haller B, Robu S, Wester HJ. et al. Single lesion on prostate-specific membrane antigen-ligand positron emission tomography and low prostate-specific antigen are prognostic factors for a favorable biochemical response to prostate-specific membrane antigen-targeted radioguided surgery in recurrent prostate cancer. Eur Urol 2019; 76: 517-23
  • 52 Ugare UG, Bassey IE, Jibrin PG, Ekanem IA. Analysis of Gleason grade and scores in 90 Nigerian Africans with prostate cancer during the period 1994 to 2004. Afr Health Sci 2012; 12: 69-73
  • 53 Uemura H, Ye D, Kanesvaran R, Chiong E, Lojanapiwat B, Pu YS. et al. United in fight against prostate cancer (UFO) registry: First results from a large, multi-centre, prospective, longitudinal cohort study of advanced prostate cancer in Asia. BJU Int 2020; 125: 541-52
  • 54 Awang A, Md Isa N, Yunus R, Azhar Shah S, Md Pauzi SH. Gleason scores in prostate needle biopsy and prostatectomy specimens in prostatic adenocarcinoma: A correlation study. Malays J Pathol 2019; 41: 253-7
  • 55 Heo JE, Ahn HK, Kim J, Chung BH, Lee KS. Changes in clinical characteristics of patients with an initial diagnosis of prostate cancer in Korea: 10-year trends reported by a tertiary center. J Korean Med Sci 2018; 33: e42
  • 56 Xu Y, Yang X, Si T, Yu H, Zhang W, Li Y. et al. Clinicopathological and prognostic factors in 106 prostate cancer patients aged ≤ 55 years: A single-center study in china. Med Sci Monit 2016; 22: 3935-42
  • 57 Zhu Y, Han CT, Chen HT, Liu F, Zhang GM, Yang WY. et al. Influence of age on predictiveness of genetic risk score for prostate cancer in a Chinese hospital-based biopsy cohort. Oncotarget 2015; 6: 22978-84
  • 58 Sarıkaya S, Resorlu M, Oguz U, Yordam M, Bozkurt OF, Unsal A. Evaluation of the pathologic results of prostate biopsies in terms of age, Gleason score and PSA level: Our experience and review of the literature. Arch Ital Urol Androl 2014; 86: 288-90
  • 59 Osman E, Gomha MA, Harb A, Aldayel A, Aloraifi I, Almousa R. et al. An early-detection programme for prostate cancer in Saudi men: A call from a tertiary-care centre in the eastern province. Arab J Urol 2014; 12: 187-91
  • 60 Shahab AA, Soebadi DM, Djatisoesanto W, Hardjowijoto S, Soetojo S, Hakim L. Prostate-specific antigen and prostate-specific antigen density cutoff points among Indonesian population suspected for prostate cancer. Prostate Int 2013; 1: 23-30
  • 61 Tsang CF, Tsu JH, Lai TC, Wong KW, Ho BS, Ng AT. et al. Pathological outcome for Chinese patients with low-risk prostate cancer eligible for active surveillance and undergoing radical prostatectomy: Comparison of six different active surveillance protocols. Hong Kong Med J 2017; 23: 609-15
  • 62 Graham J, Baker M, Macbeth F, Titshall V. Guideline Development Group. Diagnosis and treatment of prostate cancer: Summary of NICE guidance. BMJ 2008; 336: 610-2
  • 63 Petrovics G, Price DK, Lou H, Chen Y, Garland L, Bass S. et al. Increased frequency of germline BRCA2 mutations associates with prostate cancer metastasis in a racially diverse patient population. Prostate Cancer Prostatic Dis 2019; 22: 406-10
  • 64 Faraj SF, Bezerra SM, Yousefi K, Fedor H, Glavaris S, Han M. et al. Clinical validation of the 2005 ISUP Gleason grading system in a cohort of intermediate and high risk men undergoing radical prostatectomy. PLOS ONE 2016; 11: e0146189
  • 65 Pierorazio PM, Walsh PC, Partin AW, Epstein JI. Prognostic Gleason grade grouping: Data based on the modified Gleason scoring system. BJU Int 2013; 111: 753-60
  • 66 Emiogun FE, Williams OO, Obafunwa JO. Epidemiology of prostate cancer in Nigeria: Observations at Lagos State University Teaching Hospital. Cancer Health Disparities 2019 [Ahead of Print]
  • 67 Taguchi S, Uemura Y, Fujimura T, Morikawa T, Naito A, Kawai T. et al. Quantification of the individual risk of each Gleason pattern, including tertiary Gleason pattern 5, after radical prostatectomy: Development of the modified Gleason grade grouping (mGGG) model. BMC Cancer 2020; 20: 371
  • 68 Wei Y, Wu J, Gu W, Qin X, Dai B, Lin G. et al. Germline DNA repair gene mutation landscape in Chinese prostate cancer patients. Eur Urol 2019; 76: 280-3
  • 69 Cho M, Yoo S, Park J, Jeong CW, Ku JH, Kwak C. et al. Value of the new 5-tiered prostate cancer grade group system on predicting oncological outcomes for radical prostatectomy population in Korea. Korean J Urol Oncol 2018; 16: 75-81
  • 70 Yeong J, Sultana R, Teo J, Huang HH, Yuen J, Tan PH. et al. Gleason grade grouping of prostate cancer is of prognostic value in Asian men. J Clin Pathol 2017; 70: 745-53
  • 71 Khan MA, Shah H, Gul M. Prognostic stratification of prostatic cancer according to modified Gleason grading system. J Rawalpindi Med College 2016; 20: 281-4
  • 72 Epstein JI, Zelefsky MJ, Sjoberg DD, Nelson JB, Egevad L, Magi-Galluzzi C. et al. A contemporary prostate cancer grading system: A validated alternative to the Gleason score. Eur Urol 2016; 69: 428-35
  • 73 Marshall CH, Fu W, Wang H, Baras AS, Lotan TL, Antonarakis ES. Prevalence of DNA repair gene mutations in localized prostate cancer according to clinical and pathologic features: Association of Gleason score and tumor stage. Prostate Cancer Prostatic Dis 2019; 22: 59-65
  • 74 Kang DI, Chung JI, Ha HK, Min K, Yoon J, Kim W. et al. Korean prostate cancer patients have worse disease characteristics than their American counterparts. Asian Pac J Cancer Prev 2013; 14: 6913-7
  • 75 Wang FB, Chen R, Ren SC, Shi XL, Zhu YS, Zhang W. et al. Prostate cancer antigen 3 moderately improves diagnostic accuracy in Chinese patients undergoing first prostate biopsy. Asian J Androl 2017; 19: 238-43
  • 76 Huang J, Reilly KH, Zhang HZ, Wang HB. Clinical evaluation of prostate cancer gene 3 score in diagnosis among Chinese men with prostate cancer and benign prostatic hyperplasia. BMC Urol 2015; 15: 118
  • 77 Kitagawa Y, Namiki M. Prostate-specific antigen-based population screening for prostate cancer: Current status in Japan and future perspective in Asia. Asian J Androl 2015; 17: 475-80
  • 78 Lee HY, Park S, Doo SW, Yang WJ, Song YS, Kim JH. Trends in prostate cancer prevalence and radical prostatectomy rate according to age structural changes in South Korea between 2005 and 2015. Yonsei Med J 2019; 60: 257-66
  • 79 Ifere GO, Abebe F, Ananaba GA. Emergent trends in the reported incidence of prostate cancer in Nigeria. Clin Epidemiol 2012; 4: 19-32
  • 80 Hsing AW, Yeboah E, Biritwum R, Tettey Y, De Marzo AM, Adjei A. et al. High prevalence of screen detected prostate cancer in West Africans: Implications for racial disparity of prostate cancer. J Urol 2014; 192: 730-5
  • 81 Vickers AJ, Ulmert D, Sjoberg DD, Bennette CJ, Björk T, Gerdtsson A. et al. Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: Case-control study. BMJ 2013; 346: f2023
  • 82 Maruthappu M, Barnes I, Sayeed S, Ali R. Incidence of prostate and urological cancers in England by ethnic group, 2001-2007: A descriptive study. BMC Cancer 2015; 15: 753
  • 83 Odedina FT, Akinremi TO, Chinegwundoh F, Roberts R, Yu D, Reams RR. et al. Prostate cancer disparities in Black men of African descent: A comparative literature review of prostate canacer burden among black men in the United States, Caribbean, United Kingdom, and West Africa. Infect Agents Cancer 2009; 4: 52
  • 84 Zhang L, Wu S, Guo LR, Zhao XJ. Diagnostic strategies and the incidence of prostate cancer: Reasons for the low reported incidence of prostate cancer in china. Asian J Androl 2009; 11: 9-13
  • 85 Heyns CF. Is prostate cancer more common and more aggressive in African men?. Afr J Urol 2008; 14: 66-74
  • 86 Chandrasekar T, Gross L, Gomella LG, Hegarty SE, Leong JY, Giri VN. Prevalence of suspected hereditary cancer syndromes and germline mutations among a diverse cohort of probands reporting a family history of prostate cancer: Toward informing cascade testing for men. Eur Urol Oncol 2020; 3: 291-7
  • 87 Pritchard CC. Molecular insights into the germline for prostate cancer initiation, progression, and aggressiveness. Can J Urol 2019; 26: 24-6
  • 88 Pritchard CC, Mateo J, Walsh MF, De Sarkar N, Abida W, Beltran H. et al. Inherited DNA-repair gene mutations in men with metastatic prostate cancer. N Engl J Med 2016; 375: 443-53
  • 89 Lindström LS, Hall P, Hartman M, Wiklund F, Grönberg H, Czene K. Familial concordance in cancer survival: A Swedish population-based study. Lancet Oncol 2007; 8: 1001-6
  • 90 Isaacs WB, Xu J. Current progress and questions in germline genetics of prostate cancer. Asian J Urol 2019; 6: 3-9