Prevalence and Histological Patterns of Prostate Cancer Among Patients Presenting With Obstructive Lower Urinary Tract Symptoms at Mbarara Regional Referral Hospital

Abstract

Background: Prostate cancer is currently the second commonest male cancer in Uganda. Despite this, men are more likely to be tested for prostate cancer only after presenting with obstructive Lower urinary tract symptoms [1] since these are a common presenting complaint among elderly males [2]. However, there is still a lack of published local information on the clinical and biochemical patterns of prostate cancer among patients with lower urinary tract symptoms in Uganda which can negatively affects the equitable distribution of resources for cancer care. Aims: To determine the Patterns of PSA, DRE, histological findings, and prevalence of prostate cancer among patients presenting to Mbarara regional referral hospital with obstructive LUTS. MaterialsandMethods: A cross-sectional study of 140 patients with obstructive LUTS. Demographics, presenting symptoms were collected using a structured questionnaire and IPSS index, followed by total serum prostate specific antigen level estimation and Digital rectal examination. Patients who had a total serum Prostate Specific Antigen level above 4ng or an abnormal DRE underwent digitally guided transrectal prostate biopsy. Results: Majority had severe LUTS (n=103,73.57%) with a median tPSA of 14.4 ng/ml and met the criteria for the digitally guided transrectal trucut prostate biopsy(n=99,70.71%). DRE abnormalities were found in 57.14% n=80 of the participants. The commonest abnormalities were prostatic enlargement (n=76,54.29%), hard prostatic consistency (29.2% n=41), loss of the median groove (35.71% n= 50) and nodular prostate ( n=60, 42.86%). The prevalence of prostate cancer was high at 52.21% (59/11395% C.I:30.1-46.3), and over 93.3% of the cancer postive patients exhibited abnormalities on DRE. Prostate adenocarcinoma was the only histological type in all biopsies. The mean Gleason score was 8 (±1.148) and the majority had a Gleason score of 8 and above. (77.78%, n=35). Conclusions: The prevalence of prostate cancer among men presenting to Mbarara Regional referral hospital with obstructive LUTS was high and majority of these had poorly differentiated prostate adenocarcinoma.