Outcomes after Radical Prostatectomy in Ghanaians: A Surgeon's Early Experience

Background. There is a lack of expertise in the procedure of open radical retropubic prostatectomy in West Africa therefore necessitating the training of urologists in the subregion in this procedure. Aim. This report looks at the early outcomes of a single surgeon in this procedure after an SIU fellowship. Methodology. A prospective study of the initial twenty consecutive patients with clinically localized prostate cancer that underwent open radical retropubic prostatectomy at the Korle Bu Teaching hospital, Accra. Results. The mean followup was 19.5 months (range 7 months–36 months). The mean age was 62.7？yrs. For the clinical stage, 60% were T1c and 40% T2a with a mean Gleason score of 6.5. The mean estimated blood loss was 1140.0？mLs with a transfusion rate of 70%. For the pathologic stage, pT2 cancers formed 60%, pT3 25%, and pT4 5% with a mean Gleason score of 6.8. No lymph node involvement was noted. The perioperative complications rate was 15%, a postoperative potency recovery rate of 78.6% with all the patients being continent of urine. The tPSA of 95% of the patients had remained less than 0.4？ng/mL. Conclusion. The SIU scholarship offers an avenue for training in radical prostatectomy for sub-Saharan Africa. 1. Introduction The risk factors for the development of prostate cancer include men of African ancestry [1] with high incidence rate reported in some sub-Saharan countries including Ghana, 7% in men between 50？yrs and 74？yrs [2] and Nigeria with incidence rate of 127 per 100,000 population [3]. In Ghana, prostate cancer has been found to be the second commonest cause of cancer death in men [4]. With the wide-spread use of serum prostate specific antigen (PSA) screening for prostate cancer in urban areas, it is expected that more cases of early prostate cancer will be diagnosed. Radical prostatectomy has remained the gold standard for treatment of organ confined prostate cancer [5]. Though radical prostatectomy could be cost effective, it has been noted that access of patients with localized prostate cancer to radical prostatectomy in the management of prostate cancer in sub-Saharan Africa is low mainly due to lack of expertise in the procedure of open radical prostatectomy [6]. In Ghana, localized prostate cancer had been managed with external beam radiotherapy and recently brachytherapy. The role of radical prostatectomy has been limited even though majority of the patients present with lower urinary tract obstructive symptoms or acute retention of urine. This is mainly due to lack of expertise. In 2006, a program to train urologists in