34 UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE SOUTHERN AFRICAN PROSTATE CANCER STUDY (SAPCS) CREATING A ROADMAP FOR PRECISION HEALTH On 26 December 2021, South Africa said goodbye not only to a national hero, but a global hero, a man who touched the heart of everyone he met, no matter where they came from. He was a man with a vision, he fought for global equity, believed that our rainbow nation should not only be embraced, but more importantly celebrated. Archbishop Emeritus Desmond Tutu (Arch) understood the critical role that medical science can play in bringing equity to the people of South Africa and beyond, and in 2010 he became the rst African to contribute his genome (complete DNA 1 code) to the scientic community . His code, providing for the rst time a snapshot of African genetic diversity, so critical when considering treatment options for a vast number of common diseases. One of these diseases, was prostate cancer, one the Arch knew all too well. Diagnosed at 66 years of age with advanced disease, together with a team of doctors from around the world, he would battle for the next 24 years to keep his cancer at bay. A spokesperson for the Prostate Cancer Foundation (PCF) of South Africa, he knew that prostate cancer was the ‘silent killer’ within his beloved country. A signicant global health burden, prostate cancer incidence and mortality rates are dened by one’s geographic region of origin and/or ethnicity. According to the GLOBOCON 2020 cancer 2 statistics , while north-western Europe, Australia/New Zealand and north American report the highest incidence rates (age-standardised rate of 77.45 per 100,000), it is estimated that one in every 7.5 men diagnosed will die from prostate cancer, which is a stark contrast to the one in every three southern African men having received a diagnosis. A logical explanation, lack of Prostate Specic Antigen (PSA) testing in southern Africa, which in contrast has led to over diagnosis of largely indolent disease in high-incidence countries, with the practices of PSA screening for early 3 detection of prostate cancer still under debate . However, regions like the Caribbean with incidence rates mirroring that of the western countries (75.8/100,000), reports the highest mortality rates (27.9/100,000), 3.4-fold greater than their north American neighbours. Overall, Sub-Saharan African reports 2.7-fold increase in prostate cancer mortality rates over global averages, with central and southern Africa following the Caribbean for greatest impact. Ethnically, men who self-identify as being of African ancestry, have the highest risk for both incidence and specically a prostate cancer associated mortality. In the United States, African American men are at a 2.3 (≥ 65 years) to 3.1-fold (< 65 years) greater risk of dying from prostate cancer than men of European, and as much as 54,5 fold greater than men of Asian ancestries . Additionally, African American men are more likely to present with advanced disease and higher PSA levels at an earlier age, while showing faster tumour growth [6]. Taken together, being from Africa and/or of African ancestry is a signicant risk factor for aggressive prostate cancer. 1,2 3 1 Vanessa M. Hayes , Shingai B.A. Mutambirwa , M.S. Riana Bornman 1 2 School of Health Systems and Public Health, University of Pretoria, South Africa; Ancestry and Health Genomics Laboratory, Charles Perkins Centre, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, 3 NSW, Australia; Department of Urology, Sefako Makgatho Health Science University, Dr George Mukhari Academic Hospital, Medunsa, South Africa Correspondence: vanessa.hayes@sydney.edu.au (VMH); Shinga.Mutambirwa@smu.ac.za (SBAM); Riana.Bornman@up.ac.za (MSRB) In memory of Archbishop Emeritus Desmond Tutu (1931-2021)
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