Abstract

Background: Prostate cancer is one of the most common cancers in men worldwide and contributes to the proportion of patients admitted, some with advanced Gleason grade groups at Bugando Medical Centre. Serum prostate-specific antigen has been used for screening and decision-making for prostate biopsy, although its sensitivity and accuracy vary widely and its use is still controversial. Prostate specific antigen density has been reported to increase the accuracy in prostate cancer prediction and decision-making for prostate biopsy.
Objective: The study was designed to determine the utility of prostate specific antigen density in the detection of prostate cancer and its correlation with Gleason grade groups in patients with prostate-related urinary symptoms at Bugando Medical Centre.

Materials and Methods: A total of 287 patients who met the inclusion criteria were included in this cross-sectional study done from October 2023 to May 2024. Serum prostate-specific antigen levels, prostate volume by transabdominal ultrasound and prostate-specific antigen density were determined. Histopathological diagnosis was the gold standard for prostate cancer diagnosis. STATA v.13 was used for data analysis. Receiver operating characteristic curve to determine, area under the curve, optimal cut-off value, sensitivity and specificity of prostate specific antigen density for prediction of prostate cancer. The p-value less than 0.05 was considered statistically significant.

Results: Of the 287 patients, 99 (34.5%) were diagnosed with prostate cancer and 192 (65.5%) with benign conditions. The patients with prostate cancer had a median age of 73 years, a median prostate-specific antigen of 42.9 (19,224.6) ng/ml and a median prostate-specific antigen density of 0.45 (0.26,3.34) ng/ml2. The area under the curve for prostate specific antigen density was 0.9094 (0.8761 - 0.9426), with an optimal cut-off of 0.228ng/ml2, giving a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 86.9%, 82.4%, 72.2%, 92.3% and 84.0% respectively for prostate cancer prediction. Using this cutoff reduces unnecessary biopsies by 45.7%. There was a weak positive correlation between prostate specific antigen density and Gleason grade groups.

Conclusion: The prostate-specific antigen density of 0.228ng/ml2 used alone or with prostatespecific antigen in the algorithm for prostate biopsy in prostate-related symptomatic patients improves the prostate cancer diagnostic accuracy and reduces the significant number of unnecessary prostate biopsies.