Prostate Cancer: Burden and Correlation with Prostate Specific Antigen Among Screened African Men in Tanzania.

Abstract

Background: Serum prostate-specific antigen (PSA) is a widely used maker for prostate cancer (PCa) screening. However, its correlation with PCa varies, partly due to ethnic differences. This study investigated the correlation between PSA and PCa diagnosis as well as the burden of the disease in the Tanzanian community.

Methods: This community-based PCa screening took place in Northern Tanzania from May 2022 to September 2022, where men aged ≥40 years were involved. Each participant provided 5 milliliters of venous blood for PSA determination. Those with PSA levels >4 ng/mL underwent prostate biopsy. Two pathologists independently evaluated the biopsies. The correlation between PSA and biopsy results was assessed using STATA version 17.0.

Results: The study included 6164 African men with a mean age of 60±11 years. Of these, 912 (14.8%) had PSA >4 ng/mL, and hence 581 (63.7%) underwent prostate biopsy. A total of 179 men (30.8%) were histologically diagnosed with prostatic adenocarcinoma, whereby 46 (25.7%) had Gleason scores 8-9. Among participants with PSA >20 ng/mL, over 2/3 (64.7%) had PCa, rising to nearly 100% at PSA >100 ng/mL. A positive correlation between PSA levels and PCa/aggressive disease was observed. PSA sensitivity decreased with rising levels, hitting 78.2% at >10ng/mL and 24.6% at >100ng/mL, while specificity increased, peaking at 99.8% for >100ng/mL from 73.9% at >10ng/mL. The optimal PSA cut point was >10ng/mL. PSA demonstrated an 84% overall ability to predict PCa and a 71% ability to predict aggressive disease.

Conclusion: This study found a notable presence of intermediate-high grade PCa within the community, suggesting the need for regular screening and management. Moreover, PSA demonstrated clinically useful ability in predicting PCa among African men aged 40 years and older.