To assess the correlation between prostate specific antigen density and prostate biopsy results of patients with raised prostatic specific antigen levels at the Kenyatta National Hospital

Abstract

Background: Prostate cancer remains the most common cancer among Kenyan men accounting for 17.3% of all cancers countrywide. Prostate  specific Antigen Density (PSAD) is a value used to diagnose prostate cancer. No ideal PSAD has been established due to the biological differences across populations.
Objective: To determine the utility of PSAD to predict prostate cancer in patients with PSA >4ng/ml.
Methodology: The study was a prospective cross-sectional study. 77 patients at Kenyatta National Hospital with PSA levels of >4ng/ml or suspicious digital rectal examination were enrolled. Thereafter, PSA levels were tested and PSAD calculated. Prostate biopsies were then taken by finger guided or transrectal ultrasound guided methods. The data collected was uploaded into the Statistical Package for Social Sciences (SPSS) software and analysed.
Results: The average age was 69.5years. The average PSA was 94.9 ng/ml with a median of 18 ng/ml. The average prostate volume was 89.8 cc. PSAD results showed that 64.9% had PSAD values of >=0.15 , while 35.1% had <0.15. Biopsy results showed 53.2% of the patients had prostate adenocarcinoma, 39% had benign prostatic hyperplasia alone while 6 (7.8%) had benign prostatic hyperplasia with prostatitis. A PSAD of 0.23 had a sensitivity of 82.9% with a specificity of 22.2%.
Conclusion: A PSAD of 0.23 can be used as a cut-off value to predict prostate cancer when evaluating patients with raised PSA in our population.
Recommendation: A PSA density of 0.23 should be adopted as the cut-off value for screening patients for Prostate cancer in our population.