Survey of Prostate Cancer in Accra, Ghana
Condition: Prostate Cancer
MeSH terms: Prostatic Neoplasms
Study type: Observational

Summary: 
      This study, conducted at Korle-Bu Hospital in Accra, Ghana, will help elucidate the roles of
      lifestyle and genetic factors in prostate cancer risk. There is a strong variation in risk of
      prostate cancer throughout the world. The rates of the disease among African Americans are
      some of the world s highest. In the United States, the incidence of prostate cancer is 70
      percent higher in African Americans than in white Americans and the death rate in African
      Americans is almost double that of white Americans. The reasons for this excessive risk are
      unknown, but both genetic and lifestyle factors have been suggested.

      Because Africans and African Americans share similar genetic ancestry but have vastly
      different lifestyles, a better understanding of the rates and risk factor profiles for
      prostate cancer among Africans will provide important clues to what causes the disease. This
      study will try to assess the incidence of prostate cancer in the West African nation of
      Ghana. The study has two components:

        -  Clinical survey The methods of diagnosis at Korle-Bu will be evaluated and the incidence
           of prostate cancer over a 5-year period will be estimated.

        -  Screening and detection survey A survey of 1,000 men between 50 and 74 years of age will
           estimate the prevalence of both asymptomatic and undiagnosed symptomatic prostate cancer
           in the Accra population.

      The clinical survey will use data from the cancer logbook and medical records at Korle-Bu
      Hospital and the Ghanaian National Census to derive an estimate of prostate cancer incidence
      within Accra. The estimate will be low, since it will be based only on men diagnosed or
      treated at Korle-Bu and will not include men with asymptomatic disease, men diagnosed
      elsewhere, or men without access to medical care. The screening and detection survey will
      assess the presence of asymptomatic and unrecognized symptomatic prostate cancer using PSA
      testing and digital rectal examination in a random sample of 1,000 men in the general
      population of Accra. This will provide a high estimate of disease prevalence. The two
      estimates will provide an approximation of the true incidence rate of the disease in Accra.

      Comparison of these data with similar data from community surveys of African Americans will
      provide insight into reasons for the excess risk of prostate cancer in African Americans.
    

Detailed description: 
      OBJECTIVE: The key aim of this study is to assess the burden of prostate cancer in Ghana and
      to evaluate how the impact of prostate cancer among West Africans compares with that among
      African Americans, whose reported incidence rates are among the highest in the world. West
      Africans and African Americans share genetic ancestry but have very different lifestyles and
      environmental exposures. The study aim will be achieved by establishing lower and upper
      bounds on the true incidence of prostate cancer in the capital city of Accra. The secondary
      aim of the study is to establish epidemiological, biochemical, and genetic profiles of West
      Africans for comparisons with African Americans to provide etiologic clues for prostate
      cancer. DESIGN: The study will consist of two components: 1. a clinical survey, a. divided
      into a five-year retrospective, and b. a 3-year prospective phase, and 2. a population
      screening survey.
    

Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Participants for analysis were recruited through the Ghana Prostate Study-a
        population-based component, and a clinical component. The population-based component was a
        probability sample designed using the 2000 Ghana Population and Housing Census data which
        successfully recruited 1,037 healthy men between 2004 and 2006. Consented individuals
        underwent an in-person interview, and within 7 days had a digital rectal examination (DRE)
        and provided an overnight fasting blood sample for PSA testing, biomarker assays, and
        genetic analysis. Subjects who had a positive screen by PSA ([2.5 ng/ml) or DRE underwent a
        transrectal ultrasound-guided biopsy. A total of 73 histologically confirmed prostate
        cancer cases were identified through the population-based screening component of the Ghana
        Prostate Study. We also recruited 676 prostate cancer cases at Korle Bu Teaching Hospital
        in Accra, Ghana, between 2008 and 2012.
      
Keywords: African Men; Case-Control Study; Prostate Cancer; Cancer