Problems with prostate specific antigen screening for prostate cancer in the primary healthcare setting in South Africa
Article first published online: 23 MAY 2003
Volume 91, Issue 9, pages 785–788, June 2003
How to Cite
Heyns, C.F., Mathee, S., Isaacs, A., Kharwa, A., De Beer, P.M. and Pretorius, M.A. (2003), Problems with prostate specific antigen screening for prostate cancer in the primary healthcare setting in South Africa. BJU International, 91: 785–788. doi: 10.1046/j.1464-410X.2003.04241.x
- Issue published online: 23 MAY 2003
- Article first published online: 23 MAY 2003
- Accepted for publication 20 February 2003
- prostate specific antigen;
- prostate cancer;
- primary healthcare;
- racial differences;
- prostate cancer
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.
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.
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.