Prostate cancer in Asia: A collaborative report - The situation in Sri Lanka.

Dear editor,

I read with interest the article on Prostate cancer in Asia published in the inaugural issue of the Asian Journal of Urology [1]. The authors should be commended for their effort in compiling a comprehensive report. A note on the situation of prostate cancer in Sri Lanka would make it more complete; hence this letter. Sri Lanka is an island nation in South Asia situated close to South India with a population of 20 million. Prostate cancer is the 9th commonest cancer among Sri Lankan men [2]. The age adjusted rate of prostate cancer among men in Sri Lanka is 7.2/100,000 for 2007, which is the latest available data [2]. This rate is based on data collected by the National Cancer Control Programme from oncology units of the country. Therefore some underreporting is expected.

There is no prostate specific antigen (PSA) screening programme in Sri Lanka although the test is becoming widely available throughout the country. Facilities for robotic radical prostatectomy are not available in Sri Lanka. Linear accelerators and tomotherapy machines are available in few selected centres of the country. Over 90% of patients requiring androgen deprivation therapy undergo surgical orchiectomy [3]. Although available, LHRH agonists are used sparingly due to the high cost. Docetaxel, cabazitaxel, and abiraterone are available for the treatment of castration resistant prostate cancer. Enzalutamide, sipuleucel-T, and radium 223 are not yet available in Sri Lanka.

A hospital based study done over 4 years from 2010 to 2013 showed that average age at diagnosis of prostate cancer in Sri Lanka was 71 years [3]. Over 72% patients had a serum PSA >20 ng/mL at the time of diagnosis while only 7% had PSA less than 10 ng/mL. Nearly 60% had metastases at the time of diagnosis. It is interesting to note that 44% of the patients had a Gleason score of 8 or more. Even after allowances for lack of PSA screening and delayed presentation there may be an underlying factor hitherto unidentified which is responsible for this unusually high percentage. Furthermore when South Asians migrate to UK the incidence of prostate cancer increases and the proportion of high grade tumours with a Gleason score over 8 becomes markedly less [4]. These changes were evident even in the pre-PSA era. Hence it is fair to assume that there is a dietary or an environmental factor which is responsible for the low incidence and unusually high rate of Gleason score over 8 tumours in Sri Lanka – may be an agent similar to finasteride and dutasteride which also produce a similar effect.

Conflicts of interest

The author declares no conflict of interest.