Ngowi Bartholomeo Nicholaus, Mremi Alex, Seif Mshangama Juma, Kyara Yudathadeus Sebastian, Mteta Vaileth Kien, Bright Frank, Mbwambo Orgeness Jasper, Mitao Modesta Paschal, Nyindo Mramba, Mteta Kien Alfred, Mmbaga Blandina Theophil
Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Department of Urology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Res Rep Urol. 2024 Nov 21;16:315-325. doi: 10.2147/RRU.S472472. eCollection 2024.
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.
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.
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.
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.
血清前列腺特异性抗原（PSA）是一种广泛用于前列腺癌（PCa）筛查的标志物。然而，其与PCa的相关性存在差异，部分原因是种族差异。本研究调查了坦桑尼亚社区中PSA与PCa诊断之间的相关性以及该疾病的负担。
这项基于社区的PCa筛查于2022年5月至2022年9月在坦桑尼亚北部进行，纳入了年龄≥40岁的男性。每位参与者提供5毫升静脉血用于PSA测定。PSA水平>4 ng/mL的参与者接受前列腺活检。两名病理学家独立评估活检结果。使用STATA 17.0评估PSA与活检结果之间的相关性。
该研究纳入了6164名非洲男性，平均年龄为60±11岁。其中，912人（14.8%）的PSA>4 ng/mL，因此581人（63.7%）接受了前列腺活检。共有179名男性（30.8%）经组织学诊断为前列腺腺癌，其中46人（25.7%）的Gleason评分为8-9分。在PSA>20 ng/mL的参与者中，超过2/3（64.7%）患有PCa，在PSA>100 ng/mL时升至近100%。观察到PSA水平与PCa/侵袭性疾病之间存在正相关。PSA敏感性随水平升高而降低，在>10 ng/mL时为78.2%，在>100 ng/mL时为24.6%，而特异性增加，在>100 ng/mL时从>10 ng/mL时的73.9%峰值达到99.8%。最佳PSA切点为>10 ng/mL。PSA预测PCa的总体能力为84%，预测侵袭性疾病的能力为71%。
本研究发现社区中存在相当数量的中高级别PCa，提示需要进行定期筛查和管理。此外，PSA在预测40岁及以上非洲男性的PCa方面具有临床实用能力。
