Prostate Tumors (PT) are defined by an abnormal proliferation of prostate cells [1] . Two entities are distinguished: Benign Prostatic Hyperplasia (BPH) and Prostate Cancer. Benign Prostatic Hyperplasia (BPH) is defined by the World Health Organization in 2001 as an increase in prostate volume without clinical signs of malignancy, causing variated degrees of bladder outlet obstruction and it is the main pathology involved in urinary disorders in 50% of men over 50 years of age [2] . Prostate cancer is an abnormal, anarchic proliferation of more or less differentiated prostate cells, with the frequently encountered histological type being prostate adenocarcinoma at 80% [2] . The incidence of prostate tumors seems to be unequally distributed worldwide. They are in progressive evolution due to the increase in life expectancy and the improvement of screening techniques [3] . Prostate cancer has become a public health problem in recent years with more than 899,000 new cases worldwide from 2000 to 2008, accounting for 13.6% of cancers in general. It is the second most common cancer after bladder cancer and the second leading cause of cancer death of elderly men in developed countries after lung cancer, and the fourth leading cause of cancer death in both sexes [4] [5] . In 2011, the incidence of prostate cancer in France was estimated at 71,000 cases [6] . In Algeria, in the Algiers tumor registry: An increasing incidence between 2000 and 2007, with 300 new reported cases recorded annually. In Cameroon, out of 2371 urogenital tumors, a series largely dominated by prostate tumors with 512 malignant tumors (32.7%) against 1066 BPH (67.3%) [7] .

The symptomatology of prostate tumors varies according to the histological type and the progressive clinical stage of the disease, with lower urinary tract symptoms (LUTS) being the main problem. Initially, dysuria (56%) is the frequent reason for consultation in urology departments, and progressively, complications such as acute urinary retention (AUR) at 80% are the most frequent urological emergency, with prostate tumors being the main etiology [8] [9] . The clinical picture of malignant tumors, such as prostate adenocarcinoma, is dominated by bone pain; a reflection of the metastatic nature of the tumor osteophilia with a positive extension assessment in 75.9% of cases, overshadowing the associated LUTS [10] . The first-line diagnosis of a prostate tumor is clinical, based on a digital rectal examination (DRE) showing an enlarged prostate, in association with a total PSA assay. A suspicious DRE is an indication for a prostate biopsy to establish the histological confirmation diagnosis after pathological analysis [10] [11] . Renal-bladder-prostate ultrasound and endorectal ultrasound allow assessing the volume, contour and appearance of the prostate and evaluating the impact on the upper urinary tract. Radiotherapy, chemotherapy and surgery have modified the prognosis of prostate cancer, with hormone therapy remaining the most widely used due to the diversity of available techniques [12] . In Mali, prostate adenoma surgery is the main activity of the various urology departments, and transurethral resection was the reference treatment for BPH in Senegal; However, it is dominated by prostate adenomectomy in sub-Saharan Africa [4] [13] .

In Cameroon, a study at the Laquintinie Hospital in Douala in 2021 highlights bladder AUR (48.2%) as a frequent reason for consultation and the main urological emergency, with prostate tumors being the major etiology at 91.9% [14] . As we aimed to characterize PT in a northern Cameroonian population, given the region’s high prevalence of acute urinary retention (AUR) and limited research on PT in this specific locality; we carried an investigation on the epidemiological, clinical, and therapeutic aspects of prostate tumors (PT) among inpatients at the Islamic Clinic of NGaoundéré, Cameroon, over a five-year period.

We conducted a descriptive cross-sectional study with a retrospective data collection.

The study was carried out at the Islamic Clinic of N’Gaoundéré, which is a reference center for urological cancer in the northern part of Cameroon. Indeed, northern Cameroon covers three administrative regions: Adamaoua (with N’Gaoundéré as the main city), Far North (Maroua) and North (Garoua). Consequently, the Islamic Clinic of N’Gaoundéré, located in the heart of this vast northern region, represents a reference center for urological pathologies in this part of the country, which has more than 40% of the country’s population. Our study was conducted over a period of five (5) years, from January 2018 to December 2022. The study population consisted of patients who were diagnosed with a prostate tumor. All medical records of patients with a prostate tumor who received care during our study period were included.

Patients who did not receive care and incomplete or unusable records were excluded. The study was conducted by consecutive and exhaustive sampling, as all data were collected from the records of all patients received during the study period and meeting the eligibility criteria. Data collected were socio-demographic, clinical and therapeutic informations. Diagnosis of prostate tumore was confirmed based on histologic findings. File records with incomplete data were excluded from our study. Pyelocaliceal dilation was evaluated according to the Society of Fetal Urology Classification. The study received the approval of the University’s ethics committee and administrative authorization. Confidentiality of the data was ensured by the principal investigator through limited access to the study database. Data were entered and analyzed using Epi-Info software. The descriptive parameters used were proportions for categorical variables and means for quantitative variables. The frequency was calculated by reporting the number of prostate tumors received during the study period to the total number of patients received during the period.

From January 1, 2018, to December 31, 2022, a period of 5 years, we recorded 4549 hospitalizations in the urology department of the Islamic Center of Adamaoua, and 890 were primarily for the management of prostate tumors. This translates to a prostate tumor frequency of 19.6% (890/4549) in this healthcare setting ( Figure 1 ). The majority of our patients were referred from another healthcare facility

(860/890; 96.63%) of cases, compared to 3.37% of cases received in the emergency outpatient clinic ( Figure 2 ).

According to Table 1 , the most represented age group in the study population, particularly patients followed for prostate tumors, was [60-69[ years. Accounting for 35.62% of cases, with a mean age of 67.31±9.8 years and extremes ranging from 36 to 98 years. 33.33% of patients were not schooled (294/890; 32.99%), and 66.97% were schooled; 33% had formal employment, 24% were fully retired, 18% were farmers, 14% were unemployed, and 11% had informal employment. The distribution of patients according to their region of origin shows a strong predominance of those from the Adamaoua region, the study region (32.58%), the Far North (30.67%), and the North (27.87%). These three regions in the northern part of Cameroon represented nearly 91.12% of the total sample. Foreign patients accounted for 3.48% and came from Nigeria, Chad, and the Central African Republic.

The most common reason for consultation was dysuria (80.40%) of cases, followed by acute urinary retention in 25.84% of cases ( Figure 3 ). It should be noted that multiple symptoms could be associated. According to the IPSS score evaluation of the patients, a moderate symptomatology was found in the majority of cases (52.58%) and severe in 43.48% of cases; these symptoms dated back less than 6 months in 42.36% of patients ( Table 2 ).

Hypertension was the most common medical history (47.64%), followed by diabetes in 8.43% of cases. The most common surgical history was inguinal hernia repair (11.91%), followed by appendectomy (6.63%), transurethral prostate resection (TURP) (3.15%), hydrocele repairs (2.70%), and adenectomy in 1.69% of cases. The most common urological histories were schistosomiasis (18.56%), urinary tract infections (16.29%), recurrent acute urinary retention (12.37%),

urinary tract trauma (16.08%), and family history of prostate tumors in 5.57% of cases. The vast majority of patients, i.e., 76.07% of cases ( Table 3 ), had used traditional treatment.

Upon admission, 52.60% of patients had no urinary catheter, 32.99% had a bladder outlet obstruction, and 47.40% had an indwelling urinary catheter (39.80% transurethral versus 7.60% suprapubic). All patients underwent Digital rectal examination was performed, of which 19% had a stony hard prostate, 90.56% had prostate pain and 27.75% had an obliterated median groove ( Table 4 ). The predominant presumptive clinical diagnosis was benign prostatic tumor in 81.30% of cases, compared to 18.70% of prostate neoplasia after clinical examination ( Figure 4 ).

Severe anemia was found in 4.94% of patients, moderate in 16.95%, and mild in 11.80%. leukopenia was found in 0.79% of patients and leukocytosis in 2.25%. serum creatinine level was performed in 83.60% of patients, and showed impaired

renal function in 34.43% of patients. only a small proportion (11.96%) had normal PSA levels (<4 ng/ml), while the majority had elevated PSA levels, with 34.85% between 10 - 20 ng/ml, 21.65% between 20 - 100 ng/ml, and 11.55% above 100 ng/ml. The most common positive serology was Syphilis with 13.71% of cases, 2.02% of cases had positive HIV serology; the most common organism found in urine culture was Escherichia coli in 6.60% of patients and the test was sterile in the majority of cases (89.70%); it should be noted that several patients carried multiple bacteria ( Table 5 ).

The ultrasound structure of the prostate was heterogeneous in 22.92% of patients. The majority of patients (57.98%) had a moderately enlarged prostate volume (30 - 80 ml), a significant proportion (39.89%) had a large prostate (>80 ml), while only 2.13% had a normal prostate volume (<30 ml). Renal-bladder ultrasound revealed signs of bilateral pyelocalyceal dilatation, with 13.81% of patients presenting with stage 2 and 16.94% with stage 3. Furthermore, uroflowmetric measurements showed signs of severe urinary obstruction in 34.72% of patients and moderate obstruction in 42.13%, with a mean maximum flow rate (Q_max) of 8.08 ± 9.91 ml/s. These results, combined with a post-void residual volume of 241.5 ± 268.0 ml ( Table 6 ).

The analysis of the distribution of histological types among hospitalized patients followed for prostate tumors reveals a spectrum ranging from benign conditions (49.01%), such as chronic prostatitis (9.10%), adenoma (10.67%), and leiomyoma (7.64%), to precancerous lesions like prostatic intraepithelial neoplasia (PIN) (21.24%), up to the cancerous stage with adenocarcinoma (15.62%) ( Figure 5(a) ). Furthermore, the analysis of the distribution of prostate adenocarcinoma subtypes reveals a predominance of ISUP grade 4 (38.13%), followed by ISUP grade 1 (25.18%), ISUP grade 2 (12.95%), ISUP grade 3 (9.35%), ISUP grade 5 (3.60%), and 10.79% of cases classified as “unspecified” ( Figure 5(b) ).

Table 7 presents the distribution of the 139 hospitalized patients diagnosed with prostate adenocarcinoma according to their management. It is noted that the majority received palliative treatment, such as hormone therapy (4.32%), bilateral orchiectomy (11.51%), transurethral resection of the prostate (7.91%), or transvesical adenomectomy (4.32%). No patient received curative treatment by radical prostatectomy, radiotherapy, brachytherapy, or high-intensity focused ultrasound.

Table 8 deals with the 751 hospitalized patients who had been diagnosed with Benign Prostatic Hyperplasia (BPH); it can be seen that the majority of patients (95.47%) received surgical treatment, with Transurethral Resection of the Prostate (TURP) as the most frequent procedure (82.42%); the other surgical techniques used were High Vesicograde Adenomectomy (2.93%), Cervico-Prostatic Incision (1.06%), TURP associated with Orchiectomy (6.39%), and Transurethral Prostatectomy associated with Orchiectomy (2.66%); only a small proportion of patients (5.27%) received medical management, solely by the use of alpha-blockers; regarding the surgical procedures, it is noted that the majority of interventions (93.08%) were performed under spinal anesthesia; the main anatomical features found during surgery were median lobe hypertrophy (49.80%), trilobar hypertrophy (31.96%), and lateral lobe hypertrophy (13.71%). Some patients underwent additional surgical procedures such as bladder stone extraction (13.98%), inguinal hernia repair (6.52%), hydrocele repair (2.53%), and bladder diverticulectomy (1.06%).

Table 9 reveals that out of a total of 717 patients who underwent surgical treatment for benign prostate tumor, 6% developed the Transurethral Resection of the Prostate (TURP) syndrome, a potentially serious complication related to the intervention. The majority of patients (94%) did not present this complication; as for early complications, they occurred in 52.05% of patients; the most frequent were urinary tract infections (31.54%), transient urinary incontinence (9.70%), urinary retention (8.40%), wound infections (1.90%), pulmonary embolisms (1.20%), and more rarely, enterocutaneous fistulas (0.13%); regarding late complications, they were observed in 10.40% of patients. The most common are urethral strictures (2.90%), persistent urinary incontinence (2.30%), and exceptionally, pubic osteitis (0.13%).

The study also looked at the mortality and survival of these patients. In the short term, over a one-year period, the mortality rate was 1.20%, resulting in a survival rate of 98.80%; however, in the longer term, over a five-year period, the mortality rate had slightly increased to 1.85%, leaving 98.20% of patients still alive ( Figure 6 ).

In conclusion, this retrospective study conducted at the Islamic Clinic of Adamaoua provided insights into the management of prostate tumors, a common pathology and a significant source of mortality despite therapeutic advances. The results underline the importance of early diagnosis and appropriate management, primarily based on surgical intervention, to limit the morbidity and mortality associated with these pathologies. However, the retrospective nature of this study was a limitation in data collection, with incomplete clinical, biological, and ultrasonographic information at times. Additionally, the rural background of the majority of patients represented a financial constraint for the performance of additional diagnostic and exploratory examinations, as well as for the complete therapeutic management, particularly due to the unavailability of certain modalities such as chemotherapy or radiotherapy. Despite these limitations, the main strength of this work was to enable the investigation of the sociodemographic, clinical, paraclinical, and therapeutic characteristics of patients with prostate tumors in the northern regions of Cameroon. This has thus allowed for a better appreciation of the specialized management of this pathology in these localities. Furthermore, to our knowledge, this is the very first study conducted on this subject in northern Cameroon, constituting a foundation for future studies. This work also highlights the need for a multidisciplinary approach, combining conventional and traditional medicine, for optimal management of patients with prostate tumors in this region.