The Tobago Prostate Survey


In a series of studies, started in 1998, Bunker and colleagues have carried out an intense series of investigations into the prevalence of prostate cancer on the island of Tobago. This is an important series of studies that clearly indicates that the risk for prostate cancer in the Afro-Caribbean population is far higher than the risk indicated by the GLOBOCAN 2002 database.

We may summarize the key results of the Tobago Prostate Survey as follows:

  • In 2001, Bunker published early data indicating that there was a significant incidence of prostate cancer in 1,645 Afro-Caribbean males aged between 50 and 75 years of age on Tobago. Among these men, 94 percent reported 3 or 4 grandparents of African descent. Digital rectal examinations (DREs) were completed for 1,315 men, of whom findings were abnormal in 410 (31 percent). Serum PSA results were available for 1,505 men, including 412 (27.4 percent) with PSA levels > 4 ng/ml. Serum PSA levels and/or DREs were abnormal in 634 men (38.5 percent). Of these, 506 (80 percent) underwent biopsy and 218 were diagnosed with prostate cancer (218/1,645 or 13.5 percent).
  • In 2002, Bunker et al. reported updated results of the survey. This report included 2,484 male residents ranged from 40 to 79 years of age who underwent prostate cancer screening between September 1997 and June 2001. Their mean age was 55.9 ± 10.6 years, and their median age was 54 years. Of 681 men subsequently biopsied, 259 (10.4 percent of the 2,484 screened) were diagnosed with prostate cancer. These results indicate a very high screening-detected prevalence of prostate cancer in this population of West African descent. The data also support the hypothesis that populations of African descent share genetic and/or lifestyle factors that contribute to their elevated risk for prostate cancer.
  • Also in 2002, Bunker et al. published data demonstrating that the screening-detected prevalence of prostate cancer is significantly higher among men of African descent than among men of Asian-Indian descent living in Trinidad & Tobago. They compared data from a population-based sample of 1,196 male residents of Tobago of African descent to data from 173 agricultural workers of Asian-Indian descent in Trinidad. Elevated PSA levels and/or abnormal DRE were observed in 29 percent of Afro-Tobagonian men (348/1,196) as compared to 18 percent of the Asian-Indian men (31/173). Among the Afro-Tobagans, screening-detected prostate cancer prevalence was: 4.9 percent (23/468) for those aged 50-55; 7.7 percent (28/366) for those aged 55-59; and 13.3% (48/362) for those aged 60-64 years. Among the the Asian-Indian men, prostate cancer prevalence was: 1.6 percent (1/63) for those aged 50-54; 1.4 percent (1/71) for those aged 55-59; and 5.1 percent (2/39) for those aged 60-64 years.

Several additional studies have also been published by Bunker and her colleagues based on the Tobago Prostate Survey, including:

As far as we are aware, this is the most in-depth examination of screening-based risk for prostate cancer carried out to date in the Caribbean, and is suggestive of a high degree of risk for prostate cancer among Afro-Caribbeans in particular.

Content on this page last reviewed and updated September 14, 2008
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