Prostate disorders and prostate specific antigen (PSA) levels among patients above 50 years of age at Moi Teaching and Referral Hospital Eldoret

Abstract

Background: The prostate gland is a male reproductive organ that contributes fluids that nourish sperm cells in the ejaculate. Prostate problems encompass benign prostatic hyperplasia (BPH), Prostate cancer and Prostatitis. Troublesome urinary symptoms are sometimes, but not always, symptoms of prostate cancer. PSA has been a good screening Test but not of desired precision and as yet, there is no consensus among experts on the usefulness of this Test for screening asymptomatic men and also there has been no concurrence on what exact cutoff level of PSA is to be considered normal value. Elevated values of PSA are associated with prostate cancer, but they may also be seen with prostatitis and BPH. Objective: To establish the prevalence of prostate disorders among patients above 50 years of age being attended at MTRH-Eldoret and their associated PSA levels and specifically to describe the demographic and clinical characteristics of patients with prostate disorders; to determine the predictors of elevated PSA levels among patients seen at MTRH. Methodology: Cross sectional retrospective study design was used. The study population consisted of male in in-patient and out-patient units who had PSA screening as seen at MTRH. A sample of 219 patients’ records from 1st April 2012 to 31st March 2013 was reviewed. A checklist was filled by the researcher to collect data relating to the prostate disorders. Ethical clearances were obtained from IREC and permission to carry out the study was sought from the hospital administration. Results: In the study population, 74.4% were inpatient while 25.6% were outpatients. Those aged between 50-59 years were the majority at 39.7%, followed by those aged between 60-69 years (28.6%). Prevalence of prostate disorders was found to be 18.05% of which BPH had the majority of patients at 76.7%, 64.4% had enlarged prostate while 20.1% had normal prostate. Mean serum PSA among the study subjects was 31.184ng/ml with patients having PSA>4ng/ml constituting 71.7% of the study participants. Out of 54 participants that had been suspected to have prostate cancer, 40 were confirmed to have malignancy. PSA is a significant factor for malignancy p<0.05. It was noted that PSA level was rising with age (p=0.04). Family history of prostate disorders, urine retention and lower back pain were significant predictors of elevated PSA. Conclusion: The study findings showed that prevalence of prostate disorders were high among male patients’ in their 50s seeking care at MTRH. Men above seventy years of age had the highest reported cases of prostate disorders. It was evident that BPH was the most common prostate disorder seen at MTRH and there were high possibilities of BPH advancing to prostate cancer. The PSA range was significantly higher than those of African-American and Caucasian men. There is need for a population-specific reference range for African and or Kenyan men. Recommendation: All men should be sensitized and informed on the prostate gland complications and be encouraged to be screened for prostate disorders to prevent advancing complications. Further studies should be done to ascertain the cause of increased prostate complications among young men in their 50s. Health care providers should device more patient management methods that are conservative to take care of the cases that are reported late.