[show abstract][hide abstract] ABSTRACT: Abstract Objectives: To assess the value of percentage free prostate-specific antigen
(%fPSA) in the detection of prostate cancer among Nigerian men with an intermediate
total PSA level (4–10 ng/mL), and to show if the optimum threshold for
biopsy is different from Caucasian values when the widely used (six-core, digitally
directed) prostate biopsy protocol in Nigerians is applied.
Patients and methods: The study included 105 patients aged >50 years, with a
palpably benign prostate gland and intermediate levels of total PSA (4–10 ng/mL).
These patients had a free PSA assay and a transrectal digitally directed six-core
biopsy of the prostate. The %fPSA was calculated and the optimum threshold value
for detecting prostate cancer was determined.
Results: The mean (SD) age of the patients was 64.4 (6.6) years and their mean
(SD) total PSA level was 6.6 (1.7) ng/mL. Of these men 14 (13.3%) had cancer of the prostate detected by the prostate biopsy. The %fPSA level related directly to
sensitivity values but inversely to the specificity and the positive predictive values.
The best threshold of %fPSA for detecting cancer in these men was <40%, with
a sensitivity of 100%, specificity of 93.4% and a positive predictive value of 70%
Conclusions: In evaluating Nigerian patients with a palpably benign prostate
gland and within the intermediate total PSA range, when digitally directed biopsy
protocol is adopted, a %fPSA threshold of <40% will detect significant percentage
of those with prostate cancer, with a minimal number of unnecessary biopsies. This
value differs from that reported in western studies in which transrectal ultrasonography-
directed biopsy was used.
[show abstract][hide abstract] ABSTRACT: To compare the cancer detection rates of sextant and ten- core biopsy protocol amongst patients being evaluated for prostate cancer.
This is a prospective study involving 125 men with suspicion of prostate cancer. They all had an extended 10-core transrectal digitally-guided prostatic biopsy using Tru-Cut needle. Indications for biopsy were presence of one or more of the following: elevated Prostate Specific Antigen (PSA), abnormal Digital Rectal Examination (DRE) findings and abnormal prostate scan. Sextant biopsies were collected first, followed by four lateral biopsies in all patients. Both groups of specimen were kept and analyzsed separately by the same pathologist. The cancer detection rates of sextant and extended (combination of sextant and lateral) 10-core biopsy protocols were determined and compared. Pearson's Chi square and McNemar tests at two degrees of freedom with level of significance set at 0.05 ( P <0.005) were used to determine the statistical significance.
The overall cancer detection rate of 10-core prostate biopsy was 48.8%. Of all positive biopsies, the sextant biopsy protocol detected 52 cancers (85.2%) while the lateral biopsy protocol detected 58 cases (95.1%). Three (3) cancers were detected by the sextant protocol only while the lateral protocol detected nine (9) cancers where sextant technique was negative for malignancy. Ten-core extended protocol showed a statistically significant increase of 14.8% over the traditional sextant. (P=0.046). The overall complication rate of ten-core biopsy was 26.4% and the procedure was well tolerated in most patients.
We conclude that a ten-core prostate biopsy protocol significantly improves cancer detection and should be considered as the optimum biopsy protocol.
The Nigerian postgraduate medical journal 09/2012; 19(3):137-42.
[show abstract][hide abstract] ABSTRACT: IntroductionRenal cell carcinoma (RCC), regarded as the most lethal of all urological tumors, is relatively uncommon. Recent reports from developed countries indicate a rising incidence, most likely from the increasing availability of imaging services leading to an increase in incidental diagnosis of early stage tumors, with consequently better prognosis. However, literature on RCC in sub-Saharan Africa is relatively sparse.Objectives
To determine the prevalence, presentation, pattern and outcome of RCC at the Lagos University Teaching Hospital.Methods
Information extracted from the records of 64 adult patients with RCC seen in our institution between January 2000 and December 2010 included the age and sex of the patient, clinical features, investigations, tumor stage, treatment, outcome of management and follow-up.ResultsThe mean patient age was 41.8 years (range 20–75 years) with a male:female ratio of 1:1.7. Flank mass, flank pain and hematuria were present in 90.6%, 86% and 40.6% of patients, respectively, while 36% of patients had the classical triad of loin pain, loin mass and hematuria. Only 1 patient (1.6%) had an incidental diagnosis. TNM tumor stages T3 and T4 accounted for 93.7% of patients, while the clear cell type accounted for 60% of histologically examined cases. Forty-five patients (70.3%) had surgical intervention. Of the T2 patients available for follow-up, 50% were alive at 48 months, while all inoperable T4 and M1 patients available for follow-up were dead within 1 year.ConclusionRCC in our environment is characterized by a younger age at presentation, a female predominance and clinical presentation at an advanced clinical stage.
[show abstract][hide abstract] ABSTRACT: To determine if there is any change in the common causes of gross haematuria among adults Nigerians and to determine what proportion of these aetiologies is due to urological malignancies.
Consecutive adults with presenting with gross haematuria seen in our centre were studied prospectively between February 2006 and January 2007. All patients had detailed clinical and diagnostic evaluation including urine cytology, flexible/rigid urethrocystoscopy, ultrasonography and intravenous urography to determine the causes of their haematuria. Other special investigations including CT scan and tissue biopsies were only used in selected patients as indicated.
The cause of haematuria was determined in 74 patients (93.7%) while haematuria was of undetermined origin in 5 patients (6.3%). Fifteen different specific diagnoses were made as the causes of haematuria in this study. The three commonest individual causes of haematuria were benign prostatic hyperplasia (30.4%), bladder carcinoma (12.6 %) and carcinoma of the prostate (10.1%). Urological malignancies were diagnosed in 29.1 % of the patients. The Urological malignancies detected were bladder cancers (12.6 %), prostate cancers (10.1%), renal Cell Carcinoma (5.1%) and urethral Carcinoma (1.3%). The incidence of the cancers increased with age; 82.6% of the patients with malignancies were aged 50years and above while only 17.4% were below 50 years of age (P= 0.045). Urological malignancies were also more common in men (73.9 %) than in women (26.1 %) (P < 0.05).
We conclude that there is changing trend in the aetiologies of gross haematuria among adult Nigerian patients with urological malignancies being now more prevalent than previously reported in our environment.
The Nigerian postgraduate medical journal 03/2011; 18(1):30-3.
[show abstract][hide abstract] ABSTRACT: To evaluate the usefulness of prostate specific antigen (PSA) and digital rectal examination (DRE) in the diagnosis of cancer of the prostate (CaP) amongst unscreened patients.
A prospective study168 unscreened men who were referred for evaluation for CaP. They all had a 10-core extended transrectal prostatic needle biopsy using size 16 Tru Cut needle for either an elevated serum total PSA of >4ng/ml or abnormal DRE findings or both. Overall cancer detection rate was determined and detection rates were determined separately for patients with elevated PSA with normal DRE, abnormal DRE with normal PSA and those with both indications. The performances of each indication were determined separately and in combination in terms of their sensitivity, specificity, predictive values and accuracy. The results were compared amongst patients with different indications for biopsy.
The overall cancer detection rate was 44.0%. Detection rates in patients with elevated PSA with normal DRE and abnormal DRE with normal PSA were 30.0% and 17.4% respectively. There was statistically significant increased detection of 61.2% amongst patients with both indications. The overall sensitivities of PSA, DRE and combination of both were 94.6%, 75.7% and 70.3% respectively while the specificities were 20.2%, 44.7% and 64.9% respectively. The accuracies of PSA, DRE and combination of both indications were 53%, 58% and 67.3% respectively while the PPVs were 48.3%, 51.9% and 61.2% respectively. Mean Gleason score was 6.82 while the overall complication rate was 23.2%
Neither PSA nor DRE is sensitive, specific, predictive or accurate enough on its own to be an ideal screening or diagnostic test for CaP. Therefore, optimal evaluation of patients with suspected CaP is best achieved with both even in unscreened populations.
[show abstract][hide abstract] ABSTRACT: OBJECTIVE : To determine the significance of an extended 10-core transrectal biopsy protocol in different categories of patients with suspected prostate cancer using digital guidance. MATERIALS AND METHODS : We studied 125 men who were being evaluated for prostate cancer. They all had an extended 10-core digitally guided transrectal prostatic biopsy done for either an elevated serum prostate-specific antigen (PSA) or an abnormal digital rectal examination finding or both. Sextant biopsy samples were collected first, followed by additional four lateral biopsies in all patients. Both groups of specimens were analyzed separately. The cancer detection rates of both sextant and extended 10-core biopsy protocols at different PSA levels and digital rectal examination (DRE) findings were determined and compared. The level of significance of difference in cancer detection was determined using Pearson's Chi square test with level of significance set at <0.05. RESULTS : The overall cancer detection by the extended technique was 61 (48.8%) cases while the sextant protocol detected cancer in 52 cases. The 10-core extended protocol yielded an increase in cancer detection rate of 14.8% but the improvement in detection rate was only statistically significant in the sub-set of patients with PSA between 4.1 and 10 ng/mL, with or without abnormality on DRE, with an overall increase detection rate of 33%.(P=0.04) CONCLUSION : Our study has shown that a 10-core prostate biopsy protocol significantly improves cancer detection in patients with suspected early cancer. It should therefore be the optimum biopsy protocol for patients with gray-zone PSA value, with or without abnormal DRE.
Nigerian journal of clinical practice 15(3):315-9. · 0.26 Impact Factor