How Far Are We Falling Short? A Single-Centre Retrospective Analysis of Prostate Cancer Detection Rate in a Low-Resource Setting

Abstract

Prostate Cancer is the second most diagnosed cancer among men globally, and over 1.4 million men were diagnosed with the disease in 2022. Prostate biopsy practices have undergone significant evolution, transitioning from serum Prostate Specific Antigen (PSA) driven indications to multiparametric Magnetic Resonance Imaging (mpMRI) triage in many settings. Despite these, prostate cancer is still under-detected in many low-resource settings. We set out to determine the prostate cancer detection rate of our institution. Materials and Methods: We conducted a nine-year retrospective analysis (September 2017-July 2024) of patients undergoing digital-guided transrectal prostate biopsies at Federal Teaching Hospital, Lokoja. Medical abstraction was done for age, digital rectal examination (DRE) findings, PSA, and histopathological results. Biopsy indications included either suspicious DRE findings or elevated PSA (>4 ng/mL). Data analysis was performed using SPSS version 23, with descriptive statistics employed to determine detection rates. Results were presented in tabular formats. Results: A total of three hundred and sixty-three patients had prostate biopsies done over the period. The age range of patients who underwent prostate biopsy was 41 - 101 years, with a mean age of 67.8 +/- 10.4 (SD) years. The majority of patients who underwent prostate biopsies fell within the 61-70 age group; however, the cancer detection rate rose steadily with increasing age. None of the patients had their prostate biopsy done under transrectal ultrasound scan guidance, and neither did any of them have prebiopsy multiparametric Magnetic Resonance Imaging. Among the 363 biopsied patients, 234 patients had nodular hyperplasia while 129 had adenocarcinoma of the prostate, giving a prostate cancer detection rate of 35.5%. Conclusion: Prostate cancer was detected in slightly over a third of patients who underwent biopsy at our center, and detection rates rose steadily across increasing age groups.