Serum total prostate-specific antigen values in men with symptomatic prostate enlargement in Nigeria: role in clinical decision-making

Abstract

BackgroundProstatic enlargement is a common cause of bladder outlet obstruction in men in Nigeria. Malignant enlargements must be differentiated from benign enlargements for adequate treatment of each patient. High serum total prostate-specific antigen (tPSA) levels suggest malignancy, but some of the biopsies done due to a serum tPSA value >4 ng/mL would be negative for malignancy because of the low specificity of tPSA for prostate cancer. This study aims to compare the histologic findings of all prostate specimens obtained from core needle biopsy, open simple prostatectomy, and transurethral resection of the prostate with the respective serum tPSA values in an attempt to decipher the role of serum tPSA in the management of these patients.MethodsThe case notes of patients attended to from April 2009 to March 2012 were analyzed. Essentially, the age of the patient, findings on digital rectal examination, abdominopelvic ultrasonography report on the prostate, serum tPSA, and histology reports from biopsy or prostatectomy specimens as indicated were extracted for analysis.ResultsThe relationship between age, findings on digital rectal examination, serum tPSA, abdominopelvic ultrasonography report, and histology are compared. A statistically significant relationship existed between a malignant histology and age 65 years and older, suspicious findings on digital rectal examination, suspicious ultrasonography findings, and serum tPSA >10 ng/mL, but not tPSA >4 ng/mL.ConclusionIn Nigerian patients with symptomatic prostate enlargement, serum tPSA should be seen as a continuum with increasing risk of prostate malignancy.

Predicting Gleason score using the initial serum total prostate-specific antigen in Black men with symptomatic prostate adenocarcinoma in Nigeria

“…Table 1 reveals a negative correlation between age at initial presentation and iPSA, but this correlation is not significant. Generally in men, there is a significant positive correlation between age and sPSA, 19 , 20 but it seems that among men with prostate adenocarcinoma, this relationship is altered. This is similar to the finding of Yamoah et al 21 in Ghana.…”

Sensitivity and specificity of prostate-specific antigen and its surrogates towards the detection of prostate cancer in sub-Saharan Africa: a systematic review with meta-analysis

“…1). Studies were spread across six countries namely Nigeria (seven) [12,13,18,[23][24][25][26], South Africa (two) [27,28], Kenya (one) [29], Senegal (one) [30], Sudan (one) [31], and Tanzania (one) [32]. Of the 13 studies, ten studies reported sensitivity of PSA, specificity of PSA or both (Table 1).…”

“…The diagnostic accuracy of PSA has been reported with conflicts in sub-Saharan Africa. For example, PSA sensitivity and specificity of 96.3% and 18.2% respectively were reported in Nigeria [18], whereas the sensitivity of 53.3% and specificity of 37.1% were recorded in South Africa [19]. The unpredictability of the PSA test's diagnostic accuracy lies at the heart of this argument.…”

Comparison of ultrasonography findings and fine needle aspiration biopsy results in benign-malign differentiation of thyroid nodules

“…6 PSA is a serine protease produced almost exclusively by epithelial cells of the prostate gland, and the normal total PSA(TPSA) level in cases of BPH is between 0 and 4 ng/ml. 7 Serum PSA is thought to correlate well with prostate volume and it has also been suggested that high PSA levels predict BPH progression. It has been suggested that prostate volume is an important determinant of BPH progression and response to pharmacotherapy, which has become the mainstay of firstline treatment.…”