Management of Clinically Localized Prostate Cancer: Guideline Concordance and Clinical Outcomes From Tertiary Institutions in Nigeria

Abstract Purpose: Patients with clinically localized prostate cancer 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. This study aims to describe guideline concordance of cancer management and its association with patient outcomes. Methods: A 3-year retrospective study of all patients with T1-T3a, N0, M0 prostate cancer 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 guidelines was assessed. Primary endpoints were guideline concordance of staging and treatment, and associations between concordance and outcomes. Results: This study included 110 patients; mean age 68 years. Sixty-six patients (60%) were high-risk, 34 (31%) were intermediate-risk, and 9 (8%) 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 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, 16 patients (15%) received guideline-concordant definitive treatment with either radical prostatectomy (n = 10; 9%) or radiotherapy (n = 6; 5%), whereas 62 patients (56%) received non-concordant androgen deprivation therapy (ADT) alone and 21 (19%) 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: Prostate cancer 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. Citation Format: Musliu Adetola Tolani, Muhammed Ahmed, Rufus Wale Ojewola, Christian Agbo Agbo, Shehu Salihu Umar, Ernie Kaninjing, Alan Paciorek, Rebecca DeBoer. Management of Clinically Localized Prostate Cancer: Guideline Concordance and Clinical Outcomes From Tertiary Institutions in Nigeria [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 61.