Prostate specific antigen density values among patients with symptomatic prostatic enlargement in Nigeria

Background

This study aims to estimate the  prostate specific antigen density(PSAD) cut off level for detecting prostate cancer( CAP) in Nigerian men  with “grey zone PSA’’(4-10ng/ml) and normal digital rectal examination findings . We addressed this research question: Is  the international PSAD cut off of 0.15 ideal for  detecting CAP in our symptomatic patients with  “grey zone PSA’’?

 Methods

Aim:  To estimate the  prostate specific antigen density(PSAD) cut off level for detecting prostate cancer( CAP) in Nigerian men  with “grey zone PSA’’(4-10ng/ml) and normal digital rectal examination findings .

Design: prospective

Setting: A tertiary medical center in Enugu Nigeria

 Participants: Two hundred and fifty four  men with either benign prostatic hyperplasia (BPH) or  prostate cancer (CAP) were recruited.  

 Intervention: Patients with PSA above 4ng/ml or abnormal digital rectal examination or hypoecoic lesion in the prostate were biopsied.

Outcome measures:  PSAD and histology report of BPH or CAP

Results

Ninety seven patients had cancer of the prostate (CAP) while 157 has benign prostatic hyperplasia (BPH).  Seventy  two  patients had their serum PSA value within the range of 4.0 and 10ng/ml . PSAD cut off level to detect CAP was 0.04(sensitivity 95.88 %; specificity 28.7 %).

CONCLUSION        

The PSAD cut off level generated for Nigerian men in this study is 0.04 which is relatively different from international consensus. This PSAD cut off level has a positive correlation with histology and could detect patients with CAP who have “grey zone PSA’’.