Current and Future Perspectives of Prostate Cancer in Thailand
Alvarez Privado, Christian Samuel
2018
Abstract
Background Prostate cancer is the second most common malignancy among men worldwide, representing a major public health burden mostly in developed countries. Nonetheless, the burden of the disease is expected to increase in developing countries. Currently, there is limited data available describing the current and future perspectives of prostate cancer in Thailand. The aims of this dissertation were to: 1) Examine current trends and project incidence and mortality rates of prostate cancer over the next decade in Songkhla, Thailand; 2) Describe differences in prostate tumor characteristics and survival after diagnosis with prostate cancer between Buddhists and Muslims in Songkhla; 3) Evaluate the potential impact of screening for prostate cancer on the burden of the disease in Thailand. Methods Incident prostate cancer cases (1990-2014) from the Songkhla Cancer Registry, and census data from the Thai Statistical Office were used in this research. In aim 1, we used Joinpoint analysis to examine incidence and mortality trends of prostate cancer, and age-period-cohort (APC) models to assess the effect of age, calendar-year and birth-cohort on those trends. We used a comparative modeling approach to project the incidence and mortality rates of prostate cancer. In aim 2, Wilcoxon and chi-square tests were used to compare differences in prostate tumor characteristics and sociodemographic factors between Buddhists and Muslims; in addition, Kaplan Meier methods and Cox proportional hazards models were used to assess differences in survival between both religious groups. In aim 3, we conducted a simulation analysis to project the incidence and mortality of prostate cancer under different screening scenarios for the Prostate-specific antigen (PSA) test and Digital rectal examination (DRE) in the 1960-birth cohort of Songkhla males. Results The incidence and mortality rates of prostate cancer have significantly increased since 1990, and the rates are projected to continue to increase in Songkhla. The APC models suggest that birth-cohort is the most important factor driving the increased trends of prostate cancer in this population. In the second aim, we found no significant differences in prostate tumor characteristics, age, or year at diagnosis between Buddhists and Muslims. However, we observed a longer survival time in Buddhists compared to Muslims (3.8 vs 3.2; p=0.09). In addition, we found that Muslim men are more likely to die after diagnosis with prostate cancer (HR:1.27, 95%CI:0.97,1.67). In aim 3, our model projects a 28% (and 21%) reduction in the number of prostate cancer deaths at age 70, under 100% uptake of PSA (and DRE) screening. The model projects that 13,000 and 9,000 deaths per 1,000 could be prevented with 100% PSA and DRE screening uptake, respectively. Conclusions Songkhla, Thailand is an ideal setting in which to examine the temporal evolution of prostate cancer as it has a long-standing, high-quality cancer registry that has collected data throughout Thailand's ongoing transition from low- to a middle-income country. These data demonstrate the increasing prominence of prostate cancer as a public health problem in lower-resource settings. This work further demonstrates that screening could reduce mortality due to prostate cancer in this population. Further studies should evaluate the potential barriers for the implementation of screening as well as aim to elucidate the underlying risk factors contributing to the increased incidence of prostate cancer. We hope that our study provides evidence that will help support the design of policies for the control of prostate cancer in Thailand.Subjects
Prostate cancer in Thailand
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Thesis
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