The first talk I already made is about active surveillance, the perspective in Africa. As you know, active surveillance is one of the treatment modalities in prostate cancer and the rationale for this active surveillance is that most of the prostate cancer cases are indolent and they would not cause any impairment to the quality of life and to the quantity of life referred to mortality if they remain untreated. Right now we don’t have all the information that can segregate between patients who need to be treated and not. Active surveillance there is an opportunity to follow up the patient in a window of opportunity for cure where if any progression occurs you can treat the patient actively without hampering the chance of having a good outcome in the long term compared to the patient who immediately underwent treatment. So this is an ongoing process in developed countries. The difficulties of implementing active surveillance in Africa is related to the fact that when you have to do active surveillance you need the patient to have a very low risk status, a very low volume of prostate cancer. As you know, most of the cases we have are advanced so it is going to make it very difficult to have active surveillance in Africa right now. But at least we know that active surveillance gives the opportunity to follow up patients and to have more information about the natural history of the disease.
How do you detect prostate cancer with active surveillance?
We cannot do it at a large scale because the general population of prostate cancer have advanced stages. But what we have now is more and more men coming for a check without having any symptoms. They opt to check the prostate to see if there is something going on without having any symptoms. For these cases we end up sometimes having very low risk disease, very low volume of cancer in the prostate and these patients seem to have indolent cancer and we can follow them up using active surveillance. That implies regular visits where we do the digital rectal exam, do some PSA tests and repeat the biopsies just to see if the disease is progressing or not in a window, as I said, where you preserve the health-related quality of life and you don’t make the disease progress in such a way you cannot treat them.
Is there a screening programme?
No, we don’t have a screening programme but we have early detection that are opted by individuals.
What else are you discussing at AORTIC?
We are in a consortium that is called Men of African Descent Prostate Cancer that have a whole idea of understanding why we have prostate cancer at a higher incidence in black males. This is known in the US, in the Caribbean and also in Africa. So this consortium put together researchers from Africa and mostly in the United States where you have different centres involved. It is a unique opportunity for us to have all these researchers work together, being involved as investigators, not only providing data and research material but being fully involved. Right now we’re about to start a big grant where we will have more information about the genetic characteristic of prostate cancer in African males. The whole idea is to have more understanding of prostate cancer at the global perspective, worldwide, because we have black males everywhere in the world now.
Are there disparities between black African males and African-American males in terms of colon cancer?
We believe that they are close in terms of incidence and aggressiveness of the disease due to the background of this African-American, even if they are somewhat mixed with other ethnic groups or other races. But we believe that to better understand why prostate cancer is more common in African-Americans we need to know what is going on in Africa.
What are your findings so far?
We already have some results that were the basis of having this grant showing that some alleles of genes that are associated with a high risk of prostate cancer are very common among the African population whether they are controls or come from cases. So this is just a way to say that we need to understand more at the larger scale involving more patients and following them up, looking at these markers of aggressiveness through the general wide association.
Any further important notes?
This is very important to talk about this MADCaP consortium again because in the past there used to be collaboration where the African side only provided data and those people in the developed countries made publications. But this time around we are fully involved as African researchers and we share everything, we decide on the papers to do, we decide on how to share the data and this is, to me, a fair collaboration and a very promising way of moving forward.
