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.
