Presumptive androgen deprivation therapy in prostate cancer emergencies: an ambispective study of clinical presentation, diagnostic delays and early outcomes in Nigerian hospitals
DOI:
https://doi.org/10.18203/2349-2902.isj20261989Keywords:
Late stage prostate cancer, Acute complications of prostate cancer, Presumptive androgen suppression therapyAbstract
Background: Advanced prostate cancer frequently presents with life-threatening complications in low-income settings where delays in histological confirmation often impede timely treatment. In such contexts, presumptive androgen deprivation therapy (pADT) may be initiated based on strong clinical suspicion. However, evidence on its clinical application and early outcomes remains limited. This study evaluated emergency presentation patterns, diagnostic delays, and short-term outcomes following pADT in men with suspected advanced prostate cancer in South-East Nigeria.
Methods: Between December 2021 and December 2025, 45 men presenting with prostate cancer-related emergencies prior to histological confirmation were enrolled and followed for four weeks after pADT initiation. Data collected included presenting symptoms, pain severity, neurological and functional status, PSA levels, laboratory parameters, histology result, and timelines to biopsy, diagnosis, and treatment. Descriptive statistics were used for analysis.
Results: The mean age was 70.6±11.3 years. Pain was the most common symptom (60%), mainly lower back pain (88.9%). Other presentations included lower limb weakness (31.1%), limb swelling (31.1%), anaemia (28.9%), and nephropathy (28.9%). All patients had advanced disease; 82.2% had metastases, with a mean PSA of 591.9 ng/ml. pADT was administered in 95.6% of cases. At four weeks, 88.9% achieved pain scores <3 and 44.4% were pain-free; nephropathy resolved in 84.6%. Significant improvements were observed in pain, motor function, and functional status (p<0.002). Time to biopsy and histology averaged 18.6±37.0 and 18.4±14.0 days, respectively.
Conclusions: pADT offers rapid symptomatic relief and represents a pragmatic interim strategy in resource-limited settings, though strengthening diagnostic pathways remains essential.
References
Wang L, Lu B, He M, Wang Y, Wang Z, Du L. Prostate Cancer Incidence and Mortality: Global Status and Temporal Trends in 89 Countries From 2000 to 2019. Front Publ Heal. 2022;10:811044.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA. 2021;71(3):209-49.
Abiahu JA, Orakwe DE, Onuigbo CO, Onu OA, Mbaeri TU, Menkiti FE, et al. Association between fingerprint patterns and prostate cancer grade among blacks: a cross-sectional review. Int Surg J. 2025;12(10):1624-9.
Rawla P. Epidemiology of Prostate Cancer. World J Oncol. 2019;10(2):63-89.
Okeke CJ, Obi AO, Ojewola RW, Jeje EA, Okorie CO, Afogu EN, et al. Prostate Cancer and Challenges in Management in a Semi-urban Centre: A 10-year Experience. J West African College of Surgeons. 2022;12(3):44-8.
Giri VN, Egleston B, Ruth K, Uzzo RG, Chen DY, Buyyounouski M, et al. Race, genetic West African ancestry, and prostate cancer prediction by prostate-specific antigen in prospectively screened high-risk men. Cancer Prev Res (Phila). 2009;2(3):244-50.
Ferlay JEM, Lam F, Laversanne M, Colombet M, Mery L, Piñeros M, et al. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Lyon, France: International Agency for Research on Cancer; 2024. Available at: https://gco.iarc.who.int/ today. Accessed on 22 March 2026.
Schafer EJ, Laversanne M, Sung H, Soerjomataram I, Briganti A, Dahut W, et al. Recent Patterns and Trends in Global Prostate Cancer Incidence and Mortality: An Update. Europe Urol. 2025;87(3):302-13.
Badmus TA, Adesunkanmi AR, Yusuf BM, Oseni GO, Eziyi AK, Bakare TI, et al. Burden of prostate cancer in southwestern Nigeria. Urology. 2010;76(2):412-6.
Ajape AA, Ibrahim KO, Fakeye JA, Abiola OO. An overview of cancer of the prostate diagnosis and management in Nigeria: the experience in a Nigerian tertiary hospital. Annals of African medicine. 2010;9(3):113-7.
Cassell A, Yunusa B, Jalloh M, Ndoye M, Mbodji MM, Diallo A, et al. Management of Advanced and Metastatic Prostate Cancer: A Need for a Sub-Saharan Guideline. J Oncol. 2019;2019:1785428.
Mbaeri TU, Odo C, Obiesie EA, Abiahu JA, Orakwe JC. Malignant Spinal cord compression from prostate cancer in a resource poor setting: a need for improvement. Nig J Urol. 2018;8(1):7-11.
Litwin MS, Tan HJ. The Diagnosis and Treatment of Prostate Cancer: A Review. JAMA. 2017;317(24):2532-42.
Ogunbiyi OJ. Impact of health system challenges on prostate cancer control: health care experiences in Nigeria. Infectious Agents Cancer. 2011;6(2):S5.
Pain: clinical manual for nursing practice Pain: clinical manual for nursing practice Margo McCaffery Alexander Beebe Mosby Yearbook. Nurs Stand. 1994;9(11):55.
Compston A. Aids to the investigation of peripheral nerve injuries. Medical Research Council: Nerve Injuries Research Committee. With aids to the examination of the peripheral nervous system. By Michael O'Brien for the Guarantors of Brain. Saunders Elsevier, Brain. 2010;133(10):2838-44.
Srigley JR, Delahunt B, Egevad L, Samaratunga H, Yaxley J, Evans AJ. One is the new six: The International Society of Urological Pathology (ISUP) patient-focused approach to Gleason grading. Can Urolog Associat J. 2016;10(9-10):339-41.
Nzeyimana I, Nyirimodoka A, Ngendahayo E, Bonane A, Muhawenimana E, Umurangwa F, et al. Diagnosis of advanced prostate cancer at the community level in Rwanda. Int Urol Nephrol. 2021;53(10):1977-85.
Taha SM, Weng HY, Mohammed MEI, Osman YM, N'Dri N, Mohammed SI, et al. Prostate cancer clinical characteristics and outcomes in Central Sudan. Ecancermedicalscience. 2020;14:1116.
Seraphin TP, Joko-Fru WY, Manraj SS, Chokunonga E, Somdyala NIM, Korir A, et al. Prostate cancer survival in sub-Saharan Africa by age, stage at diagnosis, and human development index: a population-based registry study. Cancer Causes Control. 2021;32(9):1001-19.
Connolly RM, Carducci MA, Antonarakis ES. Use of androgen deprivation therapy in prostate cancer: indications and prevalence. Asian J Androl. 2012;14(2):177-86.
Obeng F, Korsah C, Fadil M, Agbeteti G, Amenyo OK, Okai EN, et al. Pattern and Distribution of Skeletal Metastases in Patients With Prostate Cancer in Ghana: A Descriptive Analysis and a Model-Based Digital Nomogram for Oligo-Ostotic Versus Polyostotic Metastases. Cureus. 2025;17(8):e91287.
Tazi H, Manunta A, Rodriguez A, Patard JJ, Lobel B, Guille F. Spinal cord compression in metastatic prostate cancer. Europ Urol. 2003;44(5):527-32.
Pagliarulo V, Bracarda S, Eisenberger MA, Mottet N, Schroder FH, Sternberg CN, et al. Contemporary role of androgen deprivation therapy for prostate cancer. Europ Urol. 2012;61(1):11-25.
Chen TC. Prostate cancer and spinal cord compression. Oncology (Williston Park). 2001;15(7):841-55.
Kohli M, Kaushal V, Mehta P. Role of coagulation and fibrinolytic system in prostate cancer. Seminars in thrombosis and hemostasis. 2003;29(3):301-8.
Winther-Larsen A, Sandfeld-Paulsen B, Hvas AM. Hyperfibrinolysis in Patients with Solid Malignant Neoplasms: A Systematic Review. Seminars Thrombosis Hemostasis. 2021;47(5):581-8.
Kolvenbag GJ, Nash A. Bicalutamide dosages used in the treatment of prostate cancer. Prostate. 1999;39(1):47-53.
Wellington K, Keam SJ. Bicalutamide 150mg: a review of its use in the treatment of locally advanced prostate cancer. Drugs. 2006;66(6):837-50.
Goa KL, Spencer CM. Bicalutamide in advanced prostate cancer. A review. Drugs Aging. 1998;12(5):401-22.
Stanczyk FZ, Yang JL, Coelingh Bennink HJT, Sriprasert I, Winer S, Foidart JM, et al. Comparison of estrogens and selective estrogen receptor modulators (SERMs) used for menopausal hormone therapy. Menopause. 2025;32(8):730-57.
Gilbert DC, Duong T, Kynaston HG, Alhasso AA, Cafferty FH, Rosen SD, et al. Quality-of-life outcomes from the Prostate Adenocarcinoma: TransCutaneous Hormones (PATCH) trial evaluating luteinising hormone-releasing hormone agonists versus transdermal oestradiol for androgen suppression in advanced prostate cancer. BJU Int. 2017;119(5):667-75.
Oh WK. The evolving role of estrogen therapy in prostate cancer. Clinical prostate cancer. 2002;1(2):81-9.
Langley RE, Gilbert DC, Duong T, Clarke NW, Nankivell M, Rosen SD, et al. Transdermal oestradiol for androgen suppression in prostate cancer: long-term cardiovascular outcomes from the randomised Prostate Adenocarcinoma Transcu-taneous Hormone (PATCH) trial programme. Lancet. 2021;397(10274):581-91.
Van Poznak CH. Bone health in adults treated with endocrine therapy for early breast or prostate cancer. American Society of Clinical Oncology educational book American Society of Clinical Oncology Annual Meeting. 2015;e567-74.
Bland LB, Garzotto M, DeLoughery TG, Ryan CW, Schuff KG, Wersinger EM, et al. Phase II study of transdermal estradiol in androgen-independent prostate carcinoma. Cancer. 2005;103(4):717-23.
Shore ND, Abrahamsson PA, Anderson J, Crawford ED, Lange P. New considerations for ADT in advanced prostate cancer and the emerging role of GnRH antagonists. Prostate Cancer Prostat Dis. 2013;16(1):7-15.
Moul JW. Utility of LHRH antagonists for advanced prostate cancer. Canad J Urol. 2014;21(2-1):22-7.
Maeda T, Kosaka T, Honda A, Okata U, Hayakawa N, Ito Y, et al. Evaluation of histopathological findings at the injection site following degarelix administration. Supportive Care Cancer. 2015;23(5):1377-81.
Orakwe DE, Tijani KH, Jeje EA, Ogunjimi MA, Rufus WO, Alabi TO. Bilateral subcapsular orchiectomy versus bilateral total orchiectomy: Comparison of the quality of life post-orchiectomy. Nigerian Postgraduate Med J. 2018;25(1):43-7.
Downloads
Published
How to Cite
Issue
Section
