Treatment approaches for prostate cancer in sub-Saharan Africa

Prostate cancer (CaP) represents a significant cause of cancer-related mortality on a global scale. Low- and middle-income countries (LMIC), particularly those in sub-Saharan Africa (SSA), face a disproportionate burden of this disease. Underlying genetic factors as well as barriers to early diagnosis and treatment lead to overall worse outcomes for CaP patients in SSA compared with the United States (U.S.). The number of available therapies for CaP has exploded over the last decade. Discussion of the potential impact these therapies could have on the current management of patients with metastatic CaP in SSA may help to prioritize goals for making drugs available to more patients. We review U.S. Food and Drug Administration (FDA)-approved treatments for metastatic CaP while acknowledging that many of these treatment regimens may not be feasible in SSA given barriers to medication access, significant follow-up required, and limited technological advancements needed to diagnose and treat. The purpose of this manuscript is to aid readers who may be unfamiliar with the currently approved regimens for CaP in the U.S. to provide information that may aid in prioritization of the available therapies for this cancer in SSA. Given our review of both the treatment of CaP in SSA and current treatment options available in the U.S., abiraterone has demonstrated remarkable benefits in advanced CaP and has been well-tolerated. Abiraterone and prednisone combination therapy has demonstrated significant survival benefit to patients in multiple phase three trials and given it was the first of the newer generation hormone therapies to become available, generic options are available allowing for a cost-effective option for patients. Studies have demonstrated similar efficacy when administering low-dose abiraterone taken with a low-fat meal (compared to full dose taken when fasting), which can lead to cost-savings if the drug is at a lower dose. In conclusion, abiraterone and prednisone can be clinically meaningful for patients in SSA and has a favorable and manageable side effect profile. Additional treatment options also have meaningful benefits; however, the absolute benefit of abiraterone as well as the ease of administration would favor pursuing options to make this or similar newer-generation hormone therapy available to patients in SSA.