Prevalence, clinical, and histological characteristics of prostate cancer in men with low PSA at MNRH: a cross-sectional study.

Abstract

Background: Majority of the PCa in developed countries is localized at diagnosis and survival outcomes are comparable to actual life expectancy. In Uganda however, 90% of the PCa disease is advanced at diagnosis and the 5year survival rates are less than 50%. The disease is symptomatic with high PSA levels and high Gleason score. There is a paucity of data on the character PCa among men with low PSA (4-10ng/ml) in Uganda because these men are not routinely biopsied. This contributes to the delay in diagnosis, late disease presentation, and poor outcomes Objectives: We determined the prevalence, clinical and histological characteristics of PCa in men with low PSA at MNRH. Method: This was a cross-sectional study conducted in the Urology outpatient department(OPD) at MNRH from March to October 2021. We consecutively recruited 72 men with low PSA, and used a questionnaire to capture data which was entered into Epidata version 4.1 and exported to STATA version 14.0 for analysis. Modified Poisson regression was used to determine the characteristics that are associated with PCa among men with low PSA. Results: 72 men with a mean age of 65 years (65.2 ± 9.1) and mean PSA of 7.4ng/ml (7.4 ± 2.0) were studied. The prevalence of PCa was 25.0% (95% CI: 15.3 – 36.1), 50% of these had a Gleason Score of ≥8. Straining (aPR=5.26, p=0.021), a hard prostate gland (aPR 3.97 p=0.001), obliteration of the median sulcus (aPR=2.70, p=0.003), and presence of palpable nodules (aPR=14.28, p=0.007) were significantly associated with PCa among men with low PSA Conclusion: Men with low PSA had a high prevalence of clinically symptomatic PCa. Recommendation: Biopsy men with low PSA and LUTs to enable early diagnosis of PCa and improve PCa outcomes.