Utility of prostate specific antigen (psa) in the indigenous African man

Abstract

Objectives: To examine the great possibility that the indigenous black African man with prostate diseases requires a different diagnostic approach and strategies beyond the standard PSA reference levels generated in non-African study subjects. Design: A hospital based cross-sectional descriptive study. Setting: The Urology Outpatient Clinic and Surgical Ward of Moi Teaching and Referral Hospital, Eldoret, Kenya between 1st April 2012 to 31st March 2013. Subjects: Two hundred and nineteen patients aged 50 years and above with prostate diseases. Main Outcome Measures: The main outcome measure was the PSA levels in patients diagnosed with Acute Prostatitis, Benign Prostate Hyperplasia (BPH) and Prostate Cancer in MTRH. The secondary outcome measures were the correlates associated with elevated PSA. Results: Patients ranged in age from 50 to 96 years with a mean ± standard deviation of 65.4 ± 10.2 years. Clinical diagnosis of Acute Prostatitis, BPH and Prostate Cancer was made in 1.8, 63.9 and 34.3% of the study subjects respectively. Sixty-two patients (28.3%) had PSA in the laboratory reference range of 0-4ng/ml considered normal with an average of 1.8 ng/ml. The overall mean was 31.2 ng/ml and those with elevated PSA levels had a mean of 42.3 ng/ml. There was a positive correlate between prostate enlargement, urine retention, dysuria and family history of prostate disease and elevated PSA (all with p<0.001). Conclusions: The indigenous black African man has high levels of PSA even in benign prostate diseases. This together with histological findings of malignancy in some clinically diagnosed BPH with normal range PSA levels make the use of PSA in this group a bigger challenge. Studies should be conducted to not only elucidate the best use of PSA in the indigenous black African man but also his place in the new biomarkers to supplement or replace PSA in diagnosis and care.