Bosland Maarten C, Nettey Oluwarotimi S, Phillips Adekoyejo A, Anunobi Charles C, Akinloye Oluyemi, Ekanem Ima-Obong A, Bassey Ima-Abasi E, Mehta Vikas, Macias Virgilia, van der Kwast Theodorus H, Murphy Adam B
Department of Pathology, University of Illinois at Chicago, Chicago, Illinois, USA.
Center for Global Health, University of Illinois at Chicago, Chicago, Illinois, USA.
Prostate. 2021 Jun;81(9):553-559. doi: 10.1002/pros.24133. Epub 2021 Apr 27.
Prostate cancer is the most commonly diagnosed cancer in Nigerian men despite the lack of PSA based screening. Current prevalence estimates in Nigeria are based on cancer registry data obtained primarily from hospital admissions and therefore not truly reflective of prostate cancer incidence. Prior autopsy series did not adhere to modern pathologic quality practices. The aim of this study was to explore the prevalence of asymptomatic prostate cancer among Nigerian men at the time of autopsy.
Prostates were collected at autopsy at the Universities of Lagos and Calabar Teaching Hospitals from men aged more than 40 who died from causes other than prostate cancer. Thirty-nine prostates from Nigerian men autopsied in 2017 to 2018 were formalin-fixed, weighed, and sliced at 4 mm intervals. Haematoxylin and eosin-stained paraffin sections were prepared from these slices. Presence and Gleason grade of prostatic adenocarcinomas and presence of high-grade prostatic intraepithelial neoplasia (HGPIN) were recorded.
Mean age of cases was 55 ± 11 years and mean prostatic weight was 23.0 ± 10.9 g. The crude prevalence of HGPIN was 20.6%. Overall crude prevalence of prostate cancer was 8.8% (n = 34), increasing from 8.3% for men aged 40-59 (n = 23) to 10.0% for men ≥60 years old (n = 10). Two tumors were small and had Gleason Grade 3 + 3 or 3 + 4, and one large stage T3 tumor with Gleason Grade 4 + 3 disease and neuroendocrine appearance was found in a 54-year-old man.
The 8.8% prevalence of subclinical prostate cancer at autopsy was similar to previously reported Nigerian studies with more limited tissue sampling (6.7%-10%), but considerably lower than estimates in other populations, including African Americans. Our findings suggest that latent, clinically asymptomatic prostate cancer is less frequent in Nigerians than in African Americans, despite shared genetic ancestry. Future studies with increased sample size are warranted to provide insight in the natural history and true prevalence of prostate cancer in West Africa.
尽管缺乏基于前列腺特异性抗原（PSA）的筛查，但前列腺癌仍是尼日利亚男性中最常被诊断出的癌症。尼日利亚目前的患病率估计是基于主要从医院入院病例获得的癌症登记数据，因此并不能真实反映前列腺癌的发病率。既往的尸检系列研究并未遵循现代病理学质量规范。本研究的目的是探讨尼日利亚男性尸检时无症状前列腺癌的患病率。
在拉各斯大学和卡拉巴尔教学医院尸检时，收集40岁以上因前列腺癌以外原因死亡男性的前列腺。对2017年至2018年尸检的39名尼日利亚男性的前列腺进行福尔马林固定、称重，并以4毫米间隔切片。从这些切片制备苏木精和伊红染色的石蜡切片。记录前列腺腺癌的存在情况和Gleason分级以及高级别前列腺上皮内瘤变（HGPIN）的存在情况。
病例的平均年龄为55±11岁，前列腺平均重量为23.0±10.9克。HGPIN的粗患病率为20.6%。前列腺癌的总体粗患病率为8.8%（n = 34），40 - 59岁男性的患病率从8.3%（n = 23）增加到60岁及以上男性的10.0%（n = 10）。发现两例肿瘤较小，Gleason分级为3 + 3或3 + 4，在一名54岁男性中发现一例大的T3期肿瘤，Gleason分级为4 + 3，伴有神经内分泌表现。
尸检时亚临床前列腺癌8.8%的患病率与尼日利亚先前报道的组织采样更有限的研究（6.7% - 10%）相似，但远低于其他人群的估计值，包括非裔美国人。我们的研究结果表明，尽管有共同的遗传血统，但尼日利亚人潜伏的、临床上无症状的前列腺癌比非裔美国人少见。未来需要进行样本量增加的研究，以深入了解西非前列腺癌的自然史和真实患病率。
