PSA, Gleason score and epidemiology of prostate cancer (PC) in Grenada

OBJECTIVE: To assess (1) the incidence and survival rates of PC, (2) the distribution of prostatic-specific antigen (PSA) and Gleason score in Grenada. DESIGN AND METHODS: A PC hospital-based series from the only urologist in the island was assembled. Age-adjusted incidence rates, PSA levels and Gleason scores for Grenada were analyzed and compared with US-Blacks and incidence rates from “International Agency for Research on Cancer (IARC)-contributing” Caribbean registries. RESULTS: 601 new cases of PC diagnosed between 1997-2013 equate to an annual age-adjusted incidence rate of 69.3 per 100,000 in Grenada. This is similar to the Jamaica rate of 77.3, but much inferior to those of US-Blacks 197.7 and Martinique 177.8. The median PSA level in Grenada was 18.0 ng/ml compared to 7.0 among US-Blacks (P<0.05). 47% of Grenadians with PC were in the high risk PSA category (>20ng/ml), compared to only 17% US-Blacks. Lower tract urinary infection and positive digital rectal examination were both significantly associated with high risk PSA and high risk Gleason score (Gleason sum ≥ 8). CONCLUSION: The lower PC incidence in Grenada and Jamaica is likely a reflection of lower prevalence of PSA-testing. Thus, PSA levels fall more substantially in the high risk category.

Incidence and survival for oral and pharyngeal cancer (OPC) in Grenada

OBJECTIVE: To study the epidemiology of OPC and assess the impact of age, stage at diagnosis, gender and treatment outside of Grenada on OPC survival. DESIGN AND METHODS: An OPC population-based series from the only ENT surgeon in the island was assembled. Age-adjusted incidence rates, and stage distribution were analyzed and compared with US-Blacks and incidence rates from regional registries. RESULTS: 93 cases of OPC diagnosed during 1991-2010 resulted in an annual age-adjusted incidence rate of 9.5 per 100,000 in Grenadian males and 1.7 among females. Jamaica’s rates were 5.2 and 2.3; Martinique’s 13.1 and 1.6; US-Blacks 15.1 and 5.0 respectively. The median age in Grenada was 58 years of age. In Grenada 73% of the cases presented with stage III/IV compared to 72% among US Blacks. Nearly 24% of patients had treatment outside of Grenada. CONCLUSION: OPC rates in Grenada were comparable to others in the region, attesting to the population basis of this series. Grenadian males show medium risk for OPC while the risk is low among females. Surprisingly, the tumor, node and metastasis (TNM) stage distribution in Grenada does not differ significantly from that among US Blacks for OPC, a cancer for which screening is rarely performed or possible.