THE BURDEN AND MANAGEMENT OF CASTRATE RESISTANT PROSTATE CANCER IN SUB-SAHARAN AFRICA: A NARRATIVE REVIEW

Abstract

Prostate cancer is the most common male-specific malignancy with associated significant morbidity and mortality. The management of advanced prostate cancer primarily involves the use of androgen deprivation therapy (ADT) via surgical or medical castration; however, this tends to eventually result in castrate resistance after a period of clinical and laboratory response.

This narrative review aims at providing an insight into the current modalities of treatment for castrate resistant prostate cancer (CRPC), while highlighting the challenges in its management in Sub Saharan Africa (SSA), and making recommendations to improve the quality of care for patients with CRPC in SSA.

Data was obtained through a review of published research articles, obtained via the use of online search engines - PubMed and Google Scholar, using the keywords; “Prostate Cancer”, “Castrate Resistant Prostate Cancer”, and “Sub-Saharan Africa”.

CRPC represents a clinically important subset of the global prostate cancer burden but remains poorly captured in population statistics, especially in low‑and-middle‑income countries of SSA

There have been various postulated theories on CRPC, which has guided the evolution of new and effective targeted therapy, however there are still peculiarities in the challenges of many developing countries, with respect to late presentation, high cost of treatment, and a low level of health insurance coverage, making majority of patients in SSA unable to benefit optimally from the advancements in the management of CRPC. Improving the access to timely, appropriate and affordable therapy in these regions would hence, lead to an improvement in the survival outcome of patients with CRPC.