Prostate Cancer Among Patients Presenting with Obstructive Lower Urinary Tract Symptoms at a Tertiary Hospital in South Western Uganda

Abstract

Background: Prostate cancer is currently the second commonest male cancer both globally and in Uganda. Men are often tested after presenting with obstructive lower urinary tract symptoms (LUTS). We evaluated total prostate-specific antigen patterns (tPSA), digital rectal examination (DRE) findings, histological findings and prostate cancer rates among patients presenting to Mbarara regional referral hospital with obstructive LUTS. Methods: This was a cross-sectional study of 140 patients aged ≥50 with obstructive LUTS. Data on demographics and severity of LUTS was collected, plus the results of tPSA testing and DRE. Later, digitally guided transrectal tru-cut prostate biopsy was performed, if necessary. Analysis was done using SPSS (Statistical Package for Social Scientists), version 14. Confidence interval (CI) was set at 95% and P at 0.005. Results: The majority of patients had severe LUTS (n=103, 73.57%), with a median tPSA of 14.4 ng/mL. Ninety-nine patients experienced digitally guided transrectal tru-cut prostate biopsy (70.71%; Fisher’s exact test = 0.001). DRE abnormalities were found in 57.14% (n=80) of participants and these carried a higher risk for prostate cancer diagnosis (risk ratio = 5.895; Fisher’s exact test = 0.04; CI 95%: 1.59–21.822). The tru-cut biopsy positivity rate was high, at 46% (45/99; 95% CI: 30.1–46.3); all had prostate adenocarcinoma and the majority (77.78%, n=35) had a total Gleason score of 8 and above. Of those who had a malignancy, more than a quarter were between 60–80 years of age (37.8%, n = 17). There was no statistically significant relationship between LUTs and prostate cancer diagnosis (Fisher’s exact test 2-sided = 0.84). Conclusion: Although severity of LUTS was not predictive of cancer, there was a high rate of advanced prostate cancer among study participants. DRE remains a valuable tool for identifying potential prostate cancer cases, especially in settings where PSA testing may be limited. Further research is needed to explore effective screening strategies and improve outcomes for men with prostate cancer in Uganda. Keywords: prostate cancer, prostate-specific antigen, lower urinary tract obstruction, digital rectal examinatio