Pattern and Management of Castration Resistant Prostate Cancer in Tertiary Hospital of Northwestern Nigeria: Case Series.

Abstract

Background:  Prostate  cancer  is  the  commonest urological malignancy and a commonest cause of mortality in Nigeria. The presentation is usually late due to absence of screening protocol in the country. The mortality is due to progression of the disease to castration resistance and metastasis. Objective: To present 20 case series of castration resistant prostate cancer. Case series: We present 20 case series of castration resistant prostatic cancer managed by our unit. The patients had initial medical or surgical castration with initial suppression of the prostatic specific antigen before subsequent relapse and progression. The range of duration for the castration resistance was highly variable from 3 month to 3 years. There was response to surgical castration to those on medical castration. There was initial response to maximal androgen blockade and medical adrenalectomy for those who had surgical castration before  relapse. All  resistances  are  sensitive  to abiraterone but these was limited by the cost, some cannot start it and some abandoned it after its commencement. One patient on abiraterone had mortality as compared to more than 50% of those on the other treatments. Conclusion: Castrate resistant prostate cancer is the ultimate destination of advanced prostate cancer on castration. The duration of its development is variable. Various hormonal manipulations hold promises but the most durable is the use of abiraterone in the most resistant cases. This was limited by the cost.