The high prevalence and incidence of prostate cancer is a global phenomenon [1, 2]. In the pre-Prostate Specific Antigen (PSA) era, the clinical hallmarks of prostate cancer were late disease presentations and high mortality rates . The documentation of even more advanced presentations and higher mortality rates in males of African ancestry is of great concern for countries like the Bahamas with significant populations of this ethnicity [4–10].
Over the past 15 years, there has been has been a notable change in the clinical presentation of prostate cancer, with more organ confined disease [11, 12]. Studies suggest that this documented and consistent trend in the developed countries [13–17], of early disease detection and down stage migration with associated decreasing mortalities, reflect the merits of aggressive PSA screening programs.
In the Bahamas, a Country where 85% of the population are of African ancestry, prostate cancer represents both the highest incidences of male malignancy occurrences and cancer specific deaths. Unfortunately, despite the increased campaigns for early detection since the introduction of PSA testing, there has been no down stage migration of clinical presentations of this malignancy in the Bahamas, as has occurred in the developed countries . The cultural ethos of the Caribbean male of African ancestry suggests that health preventative initiatives, inclusive of the digital rectal examination are counter to our valued macho-male image. Men therefore do not avail themselves of the publically accessible early prostate cancer detection programs.
With this high incidence of advance disease and noting that hormonal therapy remains the first treatment of choice, we sought to determine the most common treatment modality employed in our institution with regards to surgical versus medical castration. Emphasizing the need for cost effective and affordable care in our developing Country, would men of African ancestry in a macho dominated society opt to have surgical castration as the preferred treatment?