Abstract A89: Prostate cancer burden in the Bahamas: Real men die from prostate cancer

Introduction: As with other black men of West African ancestry, prostate cancer (PCa) significantly impacts Bahamian men. To address the burden of this deadly disease, an annual PCa week with community awareness programs and free prostate examinations (DRE and PSA) were introduced in the Bahamas in 1994. We conducted a retrospective study of the clinical profile of PCa prior to, and after the implementation of the annual PCa week to better understand the burden of PCa in the Bahamas. In addition, a cross-sectional survey was implemented during the 2008 PCa awareness week to explore participants' personal and family history of PCa.

Materials and Methods: For the retrospective study, PCa detection and staging were retrieved from medical records in hospitals, pathology logs, private practices and the National Department of Statistics for years 1990, 2000, and 2005. Patients were classified using D'Amico's low, medium, and high risk clinical profiles for PCa outcomes based on the three pre-treatment prognostic indicators of PSA, cancer stage and Gleason score. For the follow-up cross-sectional study in 2008, participants were recruited at the PCa screening clinics in Nassau, Bahamas. A self-administered questionnaire was given to participants during the annual PCa awareness week to assess the personal and family history of PCa. The usual descriptive analysis was used to summarize the data.

Results: There were 139 biopsy proven PCa cases identified in the Bahamas in 1990 (31 cases), 2000 (49 cases) and 2005 (59 cases). In 1990 and 2000, less than 10% of the patients had a low-risk favorable profile of a PSA less than 10, a Gleason score less than 6 and a non-clinical palpable disease. In 2005, 16% of the patients had a low-risk and 70% were in the high risk, poorly favorable group. The national cancer specific death rates for PCa were 13.6, 23.0 and 23.4 /100,000 in 1990, 2000 and 2005. The reported personal and family history of PCa by the men who participated in the 2008 survey provided an interesting view. Majority of the 100 men recruited for the study were between 40 and 49 years, married, had no college degree, employed full-time and had household income more than $30,000. None of the men reported personal history of PCa while about 11% reported that their father was diagnosed with PCa. It was curious to find that a relatively high number of the men were unsure of their family history of PCa: 25% stated that they were unsure whether their father had PCa; 16% were unsure about their brother; 6% were unsure about their son; and 2% were unsure if they were previously diagnosed with PCa. Thirty percent (30%) of the men indicated a family history of other types of cancer while 16% were unsure of their family history of other types of cancer.

Conclusion: For about 14 years, we have aggressively addressed PCa in the Bahamas through the annual community awareness programs and free prostate examinations. However, we are yet to see any significant decrease in PCa morbidity and mortality. An added concern is the uncertainty of the men about their family history of PCa. In addition to race/ethnicity (African American) and age, family history is one of the confirmed risk factors for PCa. To successfully decrease PCa morbidity and mortality in Bahamian men, it will be necessary to implement a community-based PCa educational program that will empower black men in Bahamas to take charge of their health.