PSA, Gleason score and epidemiology of prostate cancer (PC) in Grenada

OBJECTIVE: To assess (1) the incidence and survival rates of PC, (2) the distribution of prostatic-specific antigen (PSA) and Gleason score in Grenada. DESIGN AND METHODS: A PC hospital-based series from the only urologist in the island was assembled. Age-adjusted incidence rates, PSA levels and Gleason scores for Grenada were analyzed and compared with US-Blacks and incidence rates from “International Agency for Research on Cancer (IARC)-contributing” Caribbean registries. RESULTS: 601 new cases of PC diagnosed between 1997-2013 equate to an annual age-adjusted incidence rate of 69.3 per 100,000 in Grenada. This is similar to the Jamaica rate of 77.3, but much inferior to those of US-Blacks 197.7 and Martinique 177.8. The median PSA level in Grenada was 18.0 ng/ml compared to 7.0 among US-Blacks (P<0.05). 47% of Grenadians with PC were in the high risk PSA category (>20ng/ml), compared to only 17% US-Blacks. Lower tract urinary infection and positive digital rectal examination were both significantly associated with high risk PSA and high risk Gleason score (Gleason sum ≥ 8). CONCLUSION: The lower PC incidence in Grenada and Jamaica is likely a reflection of lower prevalence of PSA-testing. Thus, PSA levels fall more substantially in the high risk category.

The evolution of prostate pathology diagnosis at the UHWI: trends over a ten-year period

OBJECTIVE: During the last decade, serum prostate-specific antigen (PSA) used as a screening tool for prostate carcinoma, and the 18-guage prostate biopsy gun, which allows for relative ease of prostate gland sampling, became available at the University Hospital of the West Indies. The aim of this study was to investigate what impact these diagnostic tools have had on the histopathogy services and in the diagnosis of prostate cancer. METHODS: A retrospective search of all prostate tissue specimens received in the Department of Pathology over the ten-year period 1991 to 2000 was conducted and their histology reports examined. Parameters recorded included the type of specimen received and the diagnosis issued by the pathologist. RESULTS: Our results demonstrated a small but gradual increase in the total number of prostate specimens accessioned until 1997, followed by a marked and sustained rise. This pattern reflected almost exclusively a similar trend in the number of biopsy specimens reviewed. During the period under review, there was a marginal decrease in the number of chips accessioned but a slight increase in the number of open prostatectomies. Radical prostatectomies were frequently performed. A total number of 106 cases of carcinoma of the prostate was diagnosed from biopsy specimens (35 percent of the biopsies received) during the first 5 years of the study, compared with 362 in the latter period (48 percent of biopsies received). CONCLUSION: The availability of the serum PSA test and the prostate biopsy gun had a significant impact on the number of specimens received in the histopathology laboratory and in the diagnosis of prostate cancer in particular. (AU)

Positive predictive value (PPV) of prostate specific antigen (> ng/ml) and abnormal digital rectal exam for prostate cancer on the Caribbean island of Tobago

OBJECTIVE: To establish and compare the positive predictive values (PPV) for elevated (4 ng/ml) prostate specific antigen (PSA) and abnormal digital rectal exam (DRE) in an Afro-Caribbean population. DESIGN AND METHODS: We screened 728 men aged 40-79 years, recruited from the general population on the Caribbean island of Tobago. Ninety-five percent reported African ancestry. This population had not previously undergone screening for prostate cancer. RESULTS: PSA was elevated (> or = 4 ng/ml) and/or DRE was abnormal in 291 (40 percent) men. Pathological diagnosis of random sextant biopsies was completed in 191 (66 percent) of men. Ninety-two (13 percent) of the screened men were diagnosed with prostate cancer. Among men biopsied for abnormal DRE in the presence of normal PSA, PPV for abnormal DRE was 26 percent (11/43), range 9-50 percent across age groups. Among men with elevated PSA and normal DRE, the PPV for PSA was 46 percent (29/63), range 42-54 percent (no men aged 40-49 years (n=105) fell into this category). When all men with elevated PSA were considered, ignoring DRE status, PPV for PSA was 55 percent (79/144), range 50-60 percent. If both PSA and DRE were abnormal, the PPV was 63 percent. CONCLUSIONS: The PPV of abnormal DRE was similar to that observed in other populations undergoing screening for the first time. We speculate that a lower PSA cut-off point may be appropriate for optima ascertainment of cases in this high-risk population.(Au)

The epidemiology of prostate cancer in Jamaica

PURPOSE: Before this study, the highest reported incidence of prostate cancer in the world was thought to be among United States black men. The age adjusted rates in 1992 for United States black and white men were 249 and 182/100,000 respectively. The epidemiology of prostate cancer in Jamaica, a country of 2.5 million people of primarily African descent, was studied and compared with that of white and black Americans. MATERIALS AND METHODS: The study included 1,121 cases of prostate cancer diagnosed from 1989 to 1994. Sources of information included the Jamaican Cancer Registry, government pathology laboratory, hospital and clinic records, and physician office records. Incidence rates were computed using data from the 1991 Jamaican census. Age adjustments were made using the 1970 United States standard population. RESULTS: The average age adjusted incidence of prostate cancer in Kingston, Jamaica was 304/100,000 men. Median patient age at diagnosis was 72 years. More than 80 percent of the cases were pathologically confirmed. Of the patients 30 percent presented with acute urinary retention, 16 percent presented with bone metastases, 15 percent had gross hematuria at the time of diagnosis and an abnormal rectal examination suspicious for cancer was noted in 42 percent. Prostate specific antigen was measured in only 7 percent of cases in 1989 but in 48 percent of cases by 1994. CONCLUSIONS: These data demonstrate that Jamaican men in Kingston have a high incidence of prostate cancer, much higher than even black Americans during a similar period. Furthermore, the cancers are more significant clinically with greater morbidity in Jamaica than in the United States(AU)

Prostate cancer and PSA - a practioner's perspective

Cancer of the prostate is the commonest malignant tumor in the male. Although it exhibits a wide range of biological activity, in its late stages considerable morbidity may occur with eventual death. Early diagnosis before the tumor has spread beyond the capsule allows cure by radical prostatectomy or ablative radiotherapy. Prostate specific antigen (PSA) is a sensitive biochemical marker which although not specific for prostate cancer is elevated in 90 percent of cases with this disease. Specificity in the diagnosis of prostate cancer has been increased by using the principles of PSA density, PSA velocity, and age differential PSA normal values. If digital rectal examination (DRE) is combined with PSA testing the detection rate of early prostate cancer is greatly increased. When either the PSA is elevated or the DRE is suspicious the diagnosis should be confirmed by transrectal ultrasonography (TRUS) biopsy (AU)