Problems with prostate specific antigen screening for prostate cancer in the primary healthcare setting in South Africa

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dc.contributor.authorHeyns C.F.
dc.contributor.authorMathee S.
dc.contributor.authorIsaacs A.
dc.contributor.authorKharwa A.
dc.contributor.authorDe Beer P.M.
dc.contributor.authorPretorius M.A.
dc.date.accessioned2011-05-15T16:15:43Z
dc.date.available2011-05-15T16:15:43Z
dc.date.issued2003
dc.description.abstractOBJECTIVES: To assess the feasibility of detecting early-stage prostate cancer in the primary healthcare setting, and to investigate whether there is a higher incidence of prostate cancer in Black African men. PATIENTS AND METHODS: The study was a collaboration with registrars in the authors' institutions and primary healthcare centres serving mainly a Black African or mixed ancestry (Coloured) population in the semi-urban Cape Town metropolitan area of South Africa. Men aged 50-70 years attending the clinics were counselled about prostate cancer and invited to have a digital rectal examination (DRE), serum prostate-specific antigen (PSA) assay and transrectal ultrasonography-guided sextant prostate biopsy if the DRE was clinically suspicious of malignancy or the serum PSA was ≥4.0 ng/mL. An American Urological Association Symptom Index (AUA-SI) was obtained, and urine analysed using dipsticks. RESULTS: From May 2000 to November 2001, 660 men were assessed (mean age 59.4 years, range 30-82); 60.6% were Black African, 37.3% mixed (Coloured), 1.8% White (Caucasian) and 0.2% Asian (Indian). The mean (range) AUA-SI was 5.98 (0-35) in the whole group; the DRE was recorded as clinically suspicious of malignancy in 3.2%. The mean PSA was 20.39 (0.04-10 000) ng/mL in the whole group, but when two outliers (1865 and 10 000 ng/mL) were disregarded, it was 2.4 ng/mL. In Black patients the mean PSA was 31.8 (0.04-10 000) ng/mL, and without the outliers, 2.1 ng/mL; in Coloured patients it was 2.94 (0.05-50) ng/mL. The PSA was ≥4.0 ng/mL in 9.6% of the whole group, in 7.8% of Black and in 13% of Coloured patients. Prostate biopsies were taken in 21 patients (3.2% of the whole group and a third of those with a PSA of ≥4.0 ng/mL); in Black patients, biopsies were taken in 1.5% and 19.4%, respectively, and in Coloured patients in 6.1% and 46.9%, respectively. The prostate biopsy showed cancer in 43% of the whole group, in a third of Black and in 47% of Coloured patients; prostate cancer was detected in 1.4%, 0.5% and 2.8%, respectively. CONCLUSIONS: That prostate biopsies were obtained in only 19% of Black and in only 47% of Coloured men with a serum PSA of ≥4.0 ng/mL is of concern. This indicates that there is a significant problem in getting men with an elevated serum PSA level to undergo a prostate biopsy in the primary healthcare setting in South Africa.
dc.description.versionArticle
dc.identifier.citationBJU International
dc.identifier.citation91
dc.identifier.citation9
dc.identifier.issn14644096
dc.identifier.other10.1046/j.1464-410X.2003.04241.x
dc.identifier.urihttp://hdl.handle.net/10019.1/13457
dc.subjectprostate specific antigen
dc.subjectadult
dc.subjectaged
dc.subjectantigen detection
dc.subjectarticle
dc.subjectcancer diagnosis
dc.subjectcancer incidence
dc.subjectcontrolled study
dc.subjecthuman
dc.subjecthuman tissue
dc.subjectmale
dc.subjectnegro
dc.subjectphysical examination
dc.subjectprimary health care
dc.subjectpriority journal
dc.subjectprostate biopsy
dc.subjectprostate cancer
dc.subjectSouth Africa
dc.subjecturban population
dc.subjecturinalysis
dc.subjectAdult
dc.subjectAfrican Continental Ancestry Group
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectBiopsy
dc.subjectFeasibility Studies
dc.subjectHumans
dc.subjectIncidence
dc.subjectMale
dc.subjectMass Screening
dc.subjectMiddle Aged
dc.subjectPatient Acceptance of Health Care
dc.subjectPhysical Examination
dc.subjectPrimary Health Care
dc.subjectProstate-Specific Antigen
dc.subjectProstatic Neoplasms
dc.subjectSouth Africa
dc.titleProblems with prostate specific antigen screening for prostate cancer in the primary healthcare setting in South Africa
dc.typeArticle
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