Prostate cancer treatment with radiation therapy in Ghana: developing tailored treatment approaches and improving access to care


Prostate cancer is common among Ghanaian men, and is the second leading cause of cancer-related death for men in Ghana.  There is great need for prostate  cancer care in Ghana.

Prostate cancer in Ghana is often diagnosed based on symptoms, in contrast to PSA blood test screening as seen in the United States, and the types of tumors encountered are often more advanced than in the United States.  Public health initiatives in Ghana have, for the most part, focused on PSA screening and have not addressed improving access to treatment.

But, what about treatments for Ghanaian men with prostate cancer?  Improvements are needed and should be a priority.  Radiation therapy can improve survival and relieve symptoms for men with advanced prostate cancer.

Ghana has some radiation therapy treatment resources available, and was the site of an International Atomic Energy Association (IAEA) initiative to improve radiation therapy services (for all cancers) in Ghana.  Radiation treatment services are offered by a team of experts at Korle-Bu Teaching Hospital, and elsewhere in Accra.

Prostate cancer treatment is not currently covered by the National Health Insurance Schema (NHIS).  However, many groups are interested in improving outcomes for Ghanaian men with prostate cancer, including the Cancer Society of Ghana, the Ghana Health Service, and corporations.  We hope that these groups will lead efforts to improve prostate cancer treatment in Ghana

Doctors at Korle-Bu Hospital are currently involved in the Ghana Prostate Cancer Project, which is a survey of prostate cancer in Accra that is sponsored by the United States National Cancer Institute (NCI) and National Institute for Minority Health and Health Disparities (NIMHD).

In order to improve prostate cancer treatments for men in Ghana, we recommend that stakeholders — including the NHIS, radiation oncologists, the Cancer Society of Ghana, the Ghana Health Service, other international organization like the IAEA and the U.S. NCI and NCHMD, and interested potential corporate sponsors – convene to plan a research initiative to develop prostate cancer radiation therapy protocols that work best for Ghanaian men, resources, and geographic concerns.

Typical radiation therapy treatment schedules for prostate cancer can include up to 9 weeks of daily radiation treatments.  Novel Ghanaian treatment protocols for radiation therapy may include short course radiation therapy, which is currently a hot field of investigation in theUnited States.   These treatment approaches should be tailored to the needs of Ghanaian men and investigations led by Ghanaian radiation oncologists.

Shorter course radiation therapy, and the use of prostate seed implants, may improve access to care for Ghanaian men and could also reduce treatment costs.  The NHIS should consider participating in such research efforts by providing coverage during evidence development for men enrolled in therapeutic trials for prostate cancer radiation therapy at Korle-Bu Hospital or other sites.


7 Responses to “Prostate cancer treatment with radiation therapy in Ghana: developing tailored treatment approaches and improving access to care”

  1. Stella Ukaoma Says:

    Is there a criteria for the men that should get this PSA screening? What is the recommendation?

  2. tshowalt Says:

    Thanks for the question. Ghana’s policies for PSA screening should be refined based upon the results of the Ghana Prostate Cancer Study, but some basic principles for PSA screening can be extrapolated from US guidelines. PSA screening should start at age 45 years and should likely stop by age 80 years. PSA screening is performed annually in the United States, but could be very effective at longer intervals in Ghana.
    Diagnosis requires prostate biopsy.
    Many men in Ghana are diagnosed after developing obstructive urinary symptoms or bleeding due to advanced prostate cancer. Regardless of the route of diagnosis, and emphasis on prostate radiation therapy in Ghana, as suggested in the post, will have a positive impact for these men.

  3. jaundnein Says:

    PSA as an indicator for prostate cancer is very controversial and often not very efficient. You always have to rule out if there is a prostatitis causing elevated PSA levels; close PSA monitoring in a developing country setting (with probably high incidence of prostatitis) doesn’t seem to be the most efficient method. A simple, yet effective method still remains the digital rectal examination at regular intervals. In suspicious cases a biopsy can not be substituted by other methodologies, as it provides histological proof. After total prostatectomy PSA is good indicator to monitor recurrence. What you describe here for Ghana seems to be related to very late detection of prostate cancer, where only adjuvant treatments are possible. When it comes to obstructive urinary symptoms, radiotherapy can have adverse long-term effects, like fibrosis of the (prostatic) urethra, so it definitely can’t be the “solution” for all the problems related to prostate cancer in that setting.
    As with many treatments it doesn’t stop with making a technology available; follow-up care is crucial to making these treatments safe and effective. Indication for radiotherapy must be made carefully and in consideration of the patients overall context and treatment literacy.

  4. tshowalt Says:

    Thanks so much for the post, and great points about PSA. Most PSA screening initiatives in this setting have focused on a single PSA screening test, or very long interval testing, and not on serial testing.

    Interestingly, although obstructive urinary symptoms occur after RT, just as urinary incontinence occurs after surgery, the effect of RT on symptoms from advanced prostate cancer is often the opposite of what you suggest.

    Stage migration has altered US physicians’ perception of symptoms after prostate treatment, since US docs usually treat microscopic tumor burden. However, prostate RT is actually a very well established palliative treatment that improves obstructive symptoms for advanced prostate cancer; such use of RT was developed prior to PSA screening, when patients presented with obstructive symptoms at diagnosis. There are a number of prospective (non-randomized), older European studies to support this. Here’s a link for a recent paper on palliative prostate treatment for advanced prostate cancer

    As you point out, other options, such as surgery, may be more appropriate than RT in selected circumstances.
    Your point about follow up care is also excellent. Regardless of the treatment used, the availability of follow-up care will also be important.

    Ongoing care may be needed after radiation for obstructive symptoms, and patients who opt for surgery are at risk for urinary incontinence (particularly those with larger tumors).

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  7. dezemejor Says:

    Reblogged this on General Virtual Assistant.

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