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Mohamed Jalloh: Okay, thank you. So I have two discussion points. One is related to the evaluation in 2013 about the pathology outcomes in six African countries. It involved about 4,672 patients. The second one is a more recent prospective study of prostate cancer in West and Southern Africa.

The initial study looked at the pathology process and outcomes from 2005 to 2011 in different African countries. Next.

You can see here that all the nomenclature was available, and when it comes to Gleason 6, the sample size varied across the countries, with a proportion ranging from 13% in Uganda to 42% in South Africa. There were limited clinical data; we were just trying to see what the pathology says. Next.

This led us to study, prospectively, in a multi-center, hospital-based study, between 2016 and 2020, incident cases of prostate cancer, using a common protocol for data extraction and pathology analysis. We ended up with 2,588 prostate cancer cases between West Africa and South Africa. The majority of them, about 80%, are at high risk. Next.

If you look at the age, most of them are diagnosed at a very advanced age. Age 70 and above accounted for more than 40%. Next.
Their median PSA was very high: 48 in the [inaudible 00:01:56] quartile, even much higher. Clinical stage: CT1 was only 4.4. The Gleason Group 1 was 17%, with a much lower risk proportion of 2.9. Next.

Overall, we had 17% Gleason Grade 1, in contrast with only 2.9% low risk, which leads us to think of high PSA due to coexisting prostatitis or high-volume BPH that are under analysis currently. Age was the only independent variable associated with high risk versus low and intermediate risk pooled together.

In conclusion, there is a relatively small proportion of Gleason Grade 1 in Sub-Saharan Africa, and a much lower proportion of low risk.