Prostate-specific antigen density values among patients with symptomatic prostatic enlargement in Nigeria

BACKGROUND: This study aims to estimate the prostate-specific antigen density (PSAD) cutoff level for detecting prostate cancer (CAP) in Nigerian men with “grey zone PSA” (4–10 ng/ml) and normal digital rectal examination findings. We addressed this research question: Is the international PSAD cutoff of 0.15 ideal for detecting CAP in our symptomatic patients with “grey zone PSA?” METHODS: Aim: To estimate the prostate-specific antigen density (PSAD) cutoff level for detecting CAP in Nigerian men with “grey zone PSA” (4–10 ng/ml) and normal digital rectal examination findings. Design: Prospective. Setting: A tertiary medical center in Enugu, Nigeria. Participants: Two hundred and fifty-four men with either benign prostatic hyperplasia (BPH) or CAP were recruited. Intervention: Patients with PSA above 4 ng/ml or abnormal digital rectal examination or hypoechoic lesion in the prostate were biopsied. Outcome measures: PSAD and histology report of BPH or CAP. RESULTS: Ninety-seven patients had CAP while 157 had benign prostatic hyperplasia (BPH). Seventy-two patients had their serum PSA value within the range of 4.0 and 10 ng/ml. PSAD cutoff level to detect CAP was 0.04 (sensitivity 95.88 %; specificity 28.7 %). CONCLUSIONS: The PSAD cutoff level generated for Nigerian men in this study is 0.04 which is relatively different from international consensus. This PSAD cutoff level has a positive correlation with histology and could detect patients with CAP who have “grey zone PSA.”