Prostate cancer trends in Barbados: An analysis of the Barbados Urologic Diseases Survey database.

OBJECTIVES: To describe the burden and trend of prostate cancer (CaP) in the Caribbean island of Barbados. METHODS: All urologic pathology reports in Barbados between 1990 and 2009 were entered into the Barbados Urologic Diseases Survey (BUDS) database. All new cases of CaP were identified and the database was used to assess trends in CaP epidemiology over the study period. RESULTS: 3066 new cases of CaP were identified between 1990 and 2009. The world age-standardized rate increased steadily from 71.8 (95% CI 57.8-88.4) per 100,000 in 1990 to 112.4 (95% CI 94.0-133.7) per 100,000 in 2009, with a peak rate of 148.9 (95% CI 127.0-172.8) in 2004. The cumulative risk up to 74 years of age also increased from 11.1% in 1990 to 23.8% in 2009 with a peak of 29.9% in 2004. The mean age at diagnosis decreased from 73.1 years in 1990 to a nadir of 66.2 years in 2009. The rate of high-grade cancer (Gleason score ≥ 8) and intermediate-grade cancer (Gleason score=7) at presentation rose between 2000 and 2009 while the rate of low-grade cancer (Gleason score ≤ 6) decreased. CONCLUSIONS: Barbados suffers an unusually high burden of CaP with a trend towards more aggressive disease over the last decade. The results are important as they highlight the utility of the BUDS initiative in epidemiologic evaluation, but should be looked at cautiously due to a lack of specific details regarding screening practices in this population.

Is open surgery for the correction of stress urinary incontinence obsolete? - abstract

To identify the efficacy of the endoscopic vesical neck suspension (EVNS), Peyreya and/or Gittes procedure as well as Raz procedure. During the period July 1986-July 1990, 76 females were evaluated and treated for Stress Urinary Incontinence Grades II and III. The Gittes procedure underwent modifications. 1 - Allowed us to remove the need for a surgical incision. 2 - Allowed for the simultaneous correction of associated cystocoeles. Seventy-six females, aged 28-70 years, were included, all with clinically proved Stress Urinary Incontinence Grades II and III. Four females had their surgical procedure under local anaesthesia. The average length of stay was two days, the success rate 97 per cent, the complication rate < 5 per cent, and failures, three patients or 4 per cent. Open surgery in the treatment of stress incontinence should be reserved for those females who had failed endoscopic vesical neck suspension on two occasions. The morbidity of EVNS is, as seen, quite minimal. It is cost effective because of reduced hospital stay and, lastly the procedure is evolving along the outpatient `path' (AU)

Posterior urthral valves in the Eastern Caribbean - abstract

To ascertain the distribution, incidence, management, morbidity and mortality of posterior urethral valves (PUV) in Barbados and the islands of the Eastern Caribbean. The data were obtained through retrospective chart review of cases presenting to Queen Elizabeth Hospital during the years 1981 to 1990 inclusive. Information on 27 cases was available. The majority of these cases (70.37 percent), were from Barbados, but cases came from a total of six territories. From the results, an incidence of 98 per 100,000 in Barbados was estimated. The majority of cases (62.9 percent) were diagnosed after the first year of life. A significant number (33.2 percent) were diagnosed after the age of 10 years. There was no follow-up in 51.85 percent of cases. Of the remainder, overhalf (7/13) suffered complications of PUV or its treatment, and there was one death recorded secondary to the complications of PUV. There is a need for earlier diagnosis to avoid high morbidity and mortality. Closer attention must also be paid to follow-up in order to assess the success of treatment. This also will serve to reduce morbidity and mortality (AU)

Hyperprolactinemia in the Barbadian male - fact or fiction? - abstract

A significant number of men evaluated because of sub-fertility or erectile dysfunction were found to have hyperprolcatinae. Why? A hormone profile is required in the work-up of all male patients presenting with sub-fertility or erectile dysfunction. Two laboratories were used. Every patient with hyperprolactinemia had a repeat test done along with: 1. Complete history and physical 2. Thyroid function studies, 3. CT scan of the head 4. Neurosurgical consultation. Forty-eight males were seen from August 1990 to February 1991 with either sub-fertility, erectile dysfunction or both. Thirteen patients (27 percent) were hyperprolactinemic, nine with sub-fertility, erectile dysfuntion or both. Thirteen patients (27 percent) were hyperprolactinemic, nine with sub-fertility, three with erectile dysfunction and one patient had both problems. Abnormal pathology was found in 4 (30.7 percent), primary tumours in 3 and one patient had Kleinfelter's Syndrome. The number of hyperprolactinemic men in this group is alarmingly high. Seventy per cent of the group had no demonstrable pituitary lesion on CT scan. These men will be reviewed at six-monthly intervals. This pattern of hyperprolactinemia seems to be higher than the world literature would suggest. Why?(AU)