What is the Carcinoma Detection Rate in Patients from Southern Nigeria with Indications who had Digitally Guided Transrectal Biopsy?

Background: Most prostate cancer diagnosis comes from the histopathological evaluation of specimens obtained from prostate biopsies. It is the standard investigative modality for the diagnosis of prostate cancer. There are clinical, laboratory and imaging indications for prostate biopsy. Digital rectal examination (DRE), elevated prostate-specific antigen (PSA) levels and imaging abnormality observed during evaluation could be falsely positive or negative, and none has 100% sensitivity and specificity.

Aim: To determine the carcinoma detection rate in patients who had digitally guided transrectal prostate biopsy following indications from abnormal DRE and or elevated PSA with or without imaging findings suggestive of prostate cancer.

Materials and Methods: The study was a 6year retrospective study on patients who had prostate biopsy following abnormal DRE and or laboratory with or without imaging evaluation suspicious of PCa. They either had DRE features such as indurations and elevated PSA>10ng/ml and imaging findings suspicious of malignancy and were found to have indications for prostate biopsy. The data was coded into Excel and analyzed with SPSS version 20.

Results: 194 patients had a prostate biopsy for abnormal DRE findings, elevated PSA and or imaging indications with a mean age of 66.48yrs and age range from 29-107years. The modal range was the 60-69years age group. The histology of the biopsy in all was adenocarcinomas. The carcinoma detection rate was 34% (66) of the patients. 21.1% (41) of patients had benign prostatic hyperplasia (BPH) with prostatitis, while 44.8% (87) had only BPH. The prevalence of adenocarcinoma increases with and for aged <50years, 60-69years, 70-79years, and >80years were 0%, 17.8%, 35.5%, 48.1%, and 45.5%, respectively.

Conclusion: We found a cancer detection rate from digitally guided transrectal biopsy in patients with indications for biopsy to be 34.0%. The prevalence of high-grade PCa in the various age groups increases with age. Improving the quality of pre-biopsy evaluation capacity will enhance the validity of prostate biopsy.