Academic Journal of Suriname 2011, 2, 198-204 Biomedicine Full-length paper The incidence of malignancies of the male urogenital system in the Republic of Suriname from 1980 through 2004 Dennis R.A. Mans 1, Santosh S. Sardjoe 1, Martinus A. Vrede 2 1Department of Pharmacology, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname; 2Department of Pathology, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname Abstract The worldwide occurrence of male urogenital malignancies (cancers of prostate, penis, and testes, as well as those of kidneys and urinary bladder of men) varies from exceedingly rare to very common. In this study, incidence rates of these neoplasms in the Republic of Suriname between 1980 and 2004 have been assessed and compared with international data. Patient information was obtained from the Pathologic Anatomy Laboratory, population data from the General Bureau of Statistics. Sex-specific rates were calculated for cancer overall and for all anatomical sites, and stratified according to age groups 0 to 19, 20 to 49, and 50+ years, as well as the largest ethnic groups, viz. Hindustani, Creole, and Javanese. From these data, average yearly numbers and average rates per 100,000 men per year were calculated and expressed as means ± SDs. There were nearly 900 male urogenital malignancies in the period covered by this study, which corresponded to an overall rate of approximately 17. The most common urogenital neoplasm by far was prostatic cancer, occurring in more than three- quarters of cases and at a rate of about 13. Kidney, urinary bladder, penile, and testicular cancer were seen at rates lower than 2. The vast majority of patients, particularly those suffering from prostatic cancer, was 50 years and older and Creole. Notwithstanding, when compared with low- and high-incidence areas throughout the world, Suriname seems to represent a low-risk country for male urogenital malignancies including prostatic cancer. More comprehensive epidemiological studies in the multi-ethnic and multi-cultural society of Suriname may contribute to our understanding of the etiology of cancer. Key words: male urogenital cancers; Suriname; incidence rates; age group; ethnic background Introduction higher the grade and the stage of the tumor at presentation, the poorer the prognosis (Hellerstedt and Pienta, 2002; Micali et al., 2006; Barocas and Clark, Malignancies of the male urogenital system 2008; Feldman et al., 2008; Djouadou et al., 2010; Sun originate from prostate, penis, and testes, as well as et al., 2010). The main exception is testicular cancer, the kidneys and urinary bladder of men. These neoplasms treatment of which is regarded as one of the success are usually treated with surgery, radiation therapy, stories of modern medicine, producing sustained and/or chemotherapy (Micali et al., 2006; Barocas and responses in more than 90% of cases regardless of stage Clark, 2008; Feldman et al., 2008; Djouadou et al., 2010; (Feldman et al., 2008). Sun et al., 2010), and in the case of prostatic cancer, also Although the specific causes of male urogenital hormonal therapy in the form of androgen ablation malignancies remain unknown, a number of risk factors (Hellerstedt and Pienta, 2002). The efficacy of these has been identified. For prostatic cancer, these include, therapeutic modalities depends primarily on the stage of among others, an average age of 70 years (Hankey et al., the disease at the time of diagnosis. Generally speaking, 1999); the presence of first-degree family members with early diagnosis results in a better prognosis, but the Correspondence to: Dennis R.A. Mans, PhD, Department of Pharmacology, Faculty of Medical Sciences, Anton de Kom University. Kernkampweg 5-7, Paramaribo, Suriname. Tel/Fax: 597 441071. E-mail: [email protected] Available on-line October 25, 2011 Acad J Sur 2011 (2) 198-204 Incidence of male urogenital cancers in Suriname 199 this disease (Zeegers et al., 2003); being from African We previously reported on various aspects of descent (Brawley et al., 1998; American Cancer Society, the epidemiology of cancer in Suriname (Mans et al., 2005); and the consumption of diets high in fat but low 2003, 2007, 2008, 2010), and more recently, on the in fresh vegetables and fruits (Ma and Chapman, 2009). incidence of genitourinary malignancies in Surinamese In addition to advanced age, the risk factors for penile women (Mans et al., 2011). So far, however, no cancer include poor personal hygiene, phimosis, the comprehensive data are available on the occurrence of absence of circumcision, and infection with oncogenic urogenital malignancies in Surinamese men. For this human papilloma viruses (Madsen et al., 2008; Pow- reason, we decided to determine incidence rates of this Sang et al., 2010). Testicular cancer, on the other hand, group of neoplasms in the country, overall, as well as occurs commonly at age 20 to 39 years (Hayes-Lattin according to anatomical location, age at the time of and Nichols, 2009), in Caucasians (Shah et al., 2007), diagnosis, and ethnic background. The results have been and in men with cryptorchidism (Diekman and discussed against the background of data from low- and Pichlmeier, 2004). Renal neoplasms have been related to high-incidence countries throughout the world. end-stage renal disease (Stewart et al., 2009), hereditary predispositions such as von Hippel-Lindau syndrome Patients and methods and tuberous sclerosis (Clague et al., 2009), and environmental exposures such as analgesic abuse (Gago- Dominguez et al., 1999) and tobacco smoking (Tsivian Study population and sources of data et al., 2011). Urinary bladder cancer has mainly been In this survey, the incidence of malignancies of associated with tobacco smoking (Strope and Montie, the male urogenital system in Suriname for the period 2008), as well as environmental exposures in many between 1980 and 2004 has been determined. Benign Western countries (Ploeg et al., 2009), and chronic neoplasms, in situ carcinomas, and non-malignant skin infection with Schistosoma hematobium in certain cancers have been excluded from the study. developing countries (Parkin, 2006). Numbers of diagnoses have been obtained from Prostatic cancer is the second most frequently the records of the Pathologic Anatomical Laboratory of diagnosed cancer and the sixth leading cause of cancer the Academic Hospital Paramaribo. This institution is death in males worldwide (Jemal et al., 2011), and the the reference center for histopathological diagnosis of second most important cause of cancer mortality in cancer and for registration of all histopathologically males in the United States of America (USA) after lung diagnosed cancer cases in Suriname. The records also cancer (Jemal et al., 2010). In 2008, there were 903,500 provided information about the anatomical location of new patients with prostatic cancer throughout the world, the malignancies, the age of the patients at the moment representing 14% of overall new cancer cases, 258,400 of diagnosis, their gender, and their ethnic background. of whom died from their disease (Jemal et al., 2011). Estimations of the mid-year population size of The number of affected individuals in industrialized Suriname in the period covered by this study were countries exceeds that in Third World countries by more provided by the Section Population Statistics of the than five-fold (Jemal et al., 2011). This difference is General Bureau for Statistics, Ministry of Planning and largely attributable to the higher prevalence of risk Developmental Cooperation (General Bureau for factors in the former areas such as a longer life Statistics, 2003). expectancy and certain dietary patterns (Baade et al., 2009), as well as the higher detection rate because of Data processing better access to screening programs (Quinn and Babb, For each year in the period 1980 through 2004, 2002). Tumors of the kidney, urinary bladder, penis, and the total number of male urogenital cancers overall; the testis are much more uncommon, constituting about 2.5, total number of cancers per anatomical location 4.5, 1.0, and 0.8%, respectively, of all cancers in males (kidneys, urinary bladder, prostate, testis, and penis); the worldwide (Janout and Janoutová, 2004; Jemal et al., total number of cases in the age groups 0 to 19 years, 20 2011; Ploeg et al., 2009). However, whereas penile to 49 years, and 50 years and older; as well as the total cancer accounts for only 0.2% of neoplasms in North number of cases in the three largest ethnic groups American and European men, it comprises 10% of male (Hindustani, Creole, and Javanese) have been cancers in some parts of Africa and South America determined. For each of these subgroups, mean yearly (Antunes et al., 2007). numbers were calculated by dividing the sums by 25. The Republic of Suriname is located in the For each sub-stratum, yearly sex-specific rates north-eastern section of South America and has as its were obtained by dividing the number of cases in a capital city Paramaribo. The population of particular subgroup in a particular year by the size of the approximately 525,000 consists of Amerindians, the mid-year male population in that year, and were original inhabitants; Maroons, originating from African expressed per 100,000 men per year. Mean sex-specific slaves who arrived between the 16 th and the 19 th century; rates for each sub-stratum were obtained by adding up Creoles, a generic term referring to individuals with one the rates from 1980 to 2004 and dividing the sums by 25. or more African ancestors; the descendants from contract workers attracted from China, India, and Java Statistics (Indonesia) between the second half of the 19 th and the Data presented are means ± SDs, and have been first half of the 20 th century; as well as immigrants from evaluated for statistically significant differences on the several European and Middle East countries (Helman, basis of p values < 0.05 according to ANOVA.