Indicators for the assessment of prostate disorders at Komfo Anokye Teaching Hosptial (KATH)
This study evaluated the diagnostic accuracy of various diagnostic tools for prostate cancer and also developed nomogram for the prediction of biopsy outcome among Ghanaian men presenting with prostate disorder at Komfo Anokye Teaching Hospital. A hospital-based cross-sectional prospective study conducted at the Department of Surgery (Urology Unit) Komfo Anokye Teaching Hospital (KATH) December, 2014 to March, 2016. A total of 241 patients suspected of having prostate disorder based on 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 (ROC) analysis. These four diagnostic tools were combined into a single score to improve the diagnostic performance. Lower urinary tract symptoms (LUTS) related characteristics and questions pertaining to international prostate symptom score (IPSS) was also employed to obtain relevant data. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Two nomogram models were developed to predict the likely clinical outcome of prostate biopsies. ROC was used to assess the accuracy of the nomograms and PSA levels alone for predicting positive prostate biopsies. Prostate cancer was diagnosed in 63 patients out of 241 (26.1%). Benign prostatic hyperplasia was diagnosed in 172 (71.4%) patients and the remaining 6 (2.48%) had chronic inflammation. PSA on its own had a sensitivity of 98.4% and specificity of 16.3% respectively. PSAD had sensitivity and specificity of 84.1% and 56.7% respectively. DRE had a specificity of 69.8% but sensitivity of 67.4%. 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) than PSA (AUC=77.8) and DRE (AUC=68.6) respectively for the individual diagnostic tools. Among the different combination of diagnostic tools, bioscore combination of DRE+PSAD+PSA had better accuracy (AUC=80.6) than PSAD+DRE (AUC=78.1) PSA+PSAD+DRE+ Prostate Volume (AUC= 76.7), and PSAD+PSA (AUC=71.5) respectively. PSAD+DRE had significant higher odds (19.52) than PSA+PSAD (19.52) and PSA+DRE (13.67). The prevalence of LUTS was 88.89%. Bladder storage symptoms was recorded at 88.59%, prostate enlargement based on DRE was 60.4%. PSA levels ≥4ng/ml gave a prevalence of 81.5% while prostate enlargement defined as PSA ≥1.5ng/ml gave a prevalence of 85.23%. The accuracy of nomogram I and II for predicting a positive initial prostate biopsy were 87.5% and 84.9% 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. The most prevalent urinary tract symptoms (LUTS) were bladder storage symptoms and urgency. The accuracy of nomogram I and II for predicting a positive initial prostate biopsy was better than using individual diagnostic tools.
A thesis submitted in fulfillment of the requirements for the degree of master of philosophy (Chemical Pathology) in the Department of Molecular Medicine, School of Medical Sciences College of Health, 2016.