Problems with prostate specific antigen screening for prostate cancer in the primary healthcare setting in South Africa
dc.contributor.author | Heyns C.F. | |
dc.contributor.author | Mathee S. | |
dc.contributor.author | Isaacs A. | |
dc.contributor.author | Kharwa A. | |
dc.contributor.author | De Beer P.M. | |
dc.contributor.author | Pretorius M.A. | |
dc.date.accessioned | 2011-05-15T16:15:43Z | |
dc.date.available | 2011-05-15T16:15:43Z | |
dc.date.issued | 2003 | |
dc.description.abstract | OBJECTIVES: 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.version | Article | |
dc.identifier.citation | BJU International | |
dc.identifier.citation | 91 | |
dc.identifier.citation | 9 | |
dc.identifier.issn | 14644096 | |
dc.identifier.other | 10.1046/j.1464-410X.2003.04241.x | |
dc.identifier.uri | http://hdl.handle.net/10019.1/13457 | |
dc.subject | prostate specific antigen | |
dc.subject | adult | |
dc.subject | aged | |
dc.subject | antigen detection | |
dc.subject | article | |
dc.subject | cancer diagnosis | |
dc.subject | cancer incidence | |
dc.subject | controlled study | |
dc.subject | human | |
dc.subject | human tissue | |
dc.subject | male | |
dc.subject | negro | |
dc.subject | physical examination | |
dc.subject | primary health care | |
dc.subject | priority journal | |
dc.subject | prostate biopsy | |
dc.subject | prostate cancer | |
dc.subject | South Africa | |
dc.subject | urban population | |
dc.subject | urinalysis | |
dc.subject | Adult | |
dc.subject | African Continental Ancestry Group | |
dc.subject | Aged | |
dc.subject | Aged, 80 and over | |
dc.subject | Biopsy | |
dc.subject | Feasibility Studies | |
dc.subject | Humans | |
dc.subject | Incidence | |
dc.subject | Male | |
dc.subject | Mass Screening | |
dc.subject | Middle Aged | |
dc.subject | Patient Acceptance of Health Care | |
dc.subject | Physical Examination | |
dc.subject | Primary Health Care | |
dc.subject | Prostate-Specific Antigen | |
dc.subject | Prostatic Neoplasms | |
dc.subject | South Africa | |
dc.title | Problems with prostate specific antigen screening for prostate cancer in the primary healthcare setting in South Africa | |
dc.type | Article |