Clinicopathological Correlates of Patients with Prostate Cancer in a Tertiary Hospital in Northwestern Nigeria

Abstract

Background: Worldwide, prostate cancer is a common cause of significant morbidity and mortality in ageing men. Digital rectal examination(DRE) and serum total prostate specific antigen(tPSA) are widely used tools for prostate cancer(CaP) screening and diagnosis before transrectal ultrasound (TRUS)- guided prostate biopsy. Objectives: This study aimed at finding the clinical, biochemical, radiological and pathological correlates in patients with an enlarged prostate and elevated serum tPSA.

Methodology: This is a 12-month cross-sectional study of 80 male patients aged 50 years and above with  lower urinary tract symptoms(LUTS), abnormal digital rectal examination and/or elevated PSAgreater than 4ng/mL. Aged-matched males were also  included as a negative biopsy group with serum levels of tPSA determined using ELISA methods among both groups. Clinical, procedural (TRUS guided  biopsy) assessment, transrectal ultrasound-guided biopsies of the prostate for histological characterisation of all patients and Gleason score categorization for prostate in cancer group were done. The relationship between serum tPSA and Gleason score of prostate cancer patients was determined using Spearman's correlation.

Results: The mean serum total PSAin patients with prostate cancer and the negative biopsy group was 82.93 ±  35.02 and 28.85±30.92 ng/ml respectively. The majority of the patients in the prostate cancer group (90.0%) had suspicious findings on DRE compared to  the negative biopsy group (46.2%). There is a positive correlation between serum tPSA and Gleason score in patients with prostate cancer. Serum tPSA levels were significantly lower in the negative biopsy group. The Gleason score pattern of distribution among patients with Prostate cancer showed that the majority had a score greater than 8 and ISUP Grade V.

Conclusion: Findings of elevated total serum PSA and abnormal digital rectal examinations in  patients with an enlarged prostate in our practice are predictive of high Gleason score prostate cancer on TRUS-guided biopsy of the prostate.