Clinicopathological characteristics and primary treatment of prostate cancer in a urology unit of Sri Lanka

Aims: The aim was to describe the clinicopathological characteristics of prostate cancer and the primary treatment modality in a cohort of patients seen in a urology unit of Sri Lanka. Materials and Methods: Data were collected prospectively from all patients with newly diagnosed prostate cancer and managed in a urology unit in Sri Lanka from January 2010 to December 2013. Patients age, clinical presentation, prostate specific antigen (PSA) level, mode of diagnosis, Gleason sum score, stage of the disease and main modality of treatment were recorded and analyzed. Results: There were 278 cases of histologically proven prostate cancer. Mean patient age was 70.5 years. About 50% presented with lower urinary tract symptoms. Only 2% were screening detected cases. Five (2%) patients had a first-degree relative who had prostate cancer. About 81% of patients had a serum PSA above 20 ng/ml. Gleason sum score was 8 or more in 44% of patients. Metastases were found at the time of diagnosis in 60% of patients. Forty-eight patients underwent radical radiotherapy, while seven patients had radical prostatectomy. Most (94%) of the 203 patients who required androgen deprivation therapy had surgical orchiectomy. Conclusions: Sri Lankans appear to be having a low incidence of prostate cancer, but a larger proportion of high-grade cancers in comparison to the UK and USA. Although genetic differences may exist, a dietary or an environmental factor is more likely to be the cause for these changes. The protective effect of this factor appears to wane as South Asians emigrate and live in UK and USA.