Publication:

Presumptive androgen deprivation therapy in prostate cancer emergencies: an ambispective study of clinical presentation, diagnostic delays and early outcomes in Nigerian hospitals

Background Advanced prostate cancer frequently presents with life-threatening complications in low-income settings where delays in histological confirmation often impede timely treatment. In such contexts, presumptive androgen deprivation therapy (pADT) may be initiated based on strong clinical suspicion. However, evidence on its clinical application and early outcomes remains limited. This study evaluated emergency presentation patterns, diagnostic delays, and short-term outcomes following pADT in men with suspected advanced prostate cancer in South-East Nigeria.

Methods Between December 2021 and December 2025, 45 men presenting with prostate cancer-related emergencies prior to histological confirmation were enrolled and followed for four weeks after pADT initiation. Data collected included presenting symptoms, pain severity, neurological and functional status, PSA levels, laboratory parameters, histology result, and timelines to biopsy, diagnosis, and treatment. Descriptive statistics were used for analysis.

Results The mean age was 70.6±11.3 years. Pain was the most common symptom (60%), mainly lower back pain (88.9%). Other presentations included lower limb weakness (31.1%), limb swelling (31.1%), anaemia (28.9%), and nephropathy (28.9%). All patients had advanced disease; 82.2% had metastases, with a mean PSA of 591.9 ng/ml. pADT was administered in 95.6% of cases. At four weeks, 88.9% achieved pain scores <3 and 44.4% were pain-free; nephropathy resolved in 84.6%. Significant improvements were observed in pain, motor function, and functional status (p<0.002). Time to biopsy and histology averaged 18.6±37.0 and 18.4±14.0 days, respectively.

Conclusions pADT offers rapid symptomatic relief and represents a pragmatic interim strategy in resource-limited settings, though strengthening diagnostic pathways remains essential.