Assessment of the Performance of Specific Prostate Diagnostic Tools in the Detection of Prostate Cancer among Ghanaian Men

Abstract

Aims: This study evaluated the individual and combined performances of specific prostate diagnostic tools in the detection of prostate cancer among Ghanaian men. Study Design:  A hospital-based cross-sectional prospective study. Place and Duration of Study: Department of surgery (urology unit) Komfo Anokye Teaching Hospital (KATH) from December, 2014 to November 2015. Methodology: A total of 241 patients suspected of having prostate cancer (PCa) due to abnormal digital rectal examination (DRE) and, or elevated prostate specific antigen (PSA) level underwent Trans rectal ultrasonography guided biopsy of the prostate. Evaluation of PSA, Prostate Specific Antigen Density (PSAD), DRE, prostate volume was done using receiver operating characteristics curve analysis These four diagnostic tools were combined into a single score to improve the diagnostic performance. Results: Prostate cancer was diagnosed in 63 patients out of 241 (26.1%). Significantly elevated levels of PSA and PSAD were observed among patients with PCa compared to patients without PCa. PSAD showed better accuracy (AUC= 78.9) followed by PSA (AUC=77.8) and DRE (AUC=68.6) respectively for the individual diagnostic tools. PSAD had sensitivity and specificity of 84.1% and 56.7% respectively. Among the different combination of diagnostic tools, bioscore combination of DRE+PSAD+PSA had better accuracy (AUC=80.6) followed by PSAD+DRE (AUC=78.1) PSA+PSAD+DRE+ Prostate Volume (AUC= 76.7), and for PSAD+PSA (AUC=71.5) respectively. PSA on its own had a sensitivity of 98.4% and specificity of 16.3% respectively. The best statistically significant (p<0.05) odds ratio (OR) for the combination of PSAD+DRE was 33.40 followed by PSA+PSAD at 19.52 and PSA+DRE at 13.67 respectively. Conclusion: Combined diagnostic performance of DRE+PSAD+PSA poses a better diagnostic accuracy. Bioscores for the combination of the diagnostic tools were significantly associated with increasing odds of prostate cancer detection upon logistic regression analysis. Further studies are required to evaluate the combine diagnostic performance in larger population.