Waiting Times in Prostate Cancer Diagnosis and Treatment: A Ten-Year Experience in A Nigerian Teaching Hospital.

INTRODUCTION: Prostate cancer is still the leading male cancer and the leading cause of cancer deaths in Nigeria, and other low- and middle-income countries (LMIC) in Sub-Saharan Africa. Early diagnosis is essential to ensuring prompt treatment and reducing morbidity and mortality. Reducing the waiting times for diagnosis and treatment is therefore important. AIMS AND OBJECTIVES: To study prostate cancer management waiting times, to serve as a baseline in improving the quality of cancer care in the Nigerian populace. PATIENTS AND METHODS: This was a ten-year retrospective study of waiting times of all histologically-confirmed prostate cancer patients seen at Alex-Ekwueme Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. Statistical analysis was done SPSS version 26. A P-value less than 0.05 was considered statistically significant. RESULTS: A total of 189 patients presented with prostate cancer; however, 73 patients with complete data were analysed. The mean age of the patients was 71.48±8.16 years. The median duration of symptoms before presentation was 6 months. The mean total prostate-specific antigen was 82.08±54.9ng/mL. The mean duration between the first visit to the definitive diagnosis was 6.53±11.68 months with a median of 1 month. The median duration from visit to treatment was 3 months with a mean of 9.71±13.4 months. There were no associations between occupation, highest educational level, financial constraints, and the different waiting times studied (P>0.05). CONCLUSION: The waiting times for prostate cancer management were unduly prolonged in this study; patient-related factors did not influence this wait. INTRODUCTION: Le cancer de la prostate est toujours le principal cancer chez les hommes et la principale cause de décès par cancer au Nigéria et dans d'autres pays à revenu faible et intermédiaire (PFR) en Afrique subsaharienne. Un diagnostic précoce est essentiel pour garantir un traitement rapide et réduire la morbidité et la mortalité. Il est donc important de réduire les délais d'attente pour le diagnostic et le traitement. OBJECTIFS: Étudier les délais d'attente dans la prise en charge du cancer de la prostate, afin de servir de référence pour améliorer la qualité des soins contre le cancer dans la population nigériane. PATIENTS ET MÉTHODES: Il s'agit d'une étude rétrospective de dix ans sur les délais d'attente de tous les patients atteints de cancer de la prostate confirmé histologiquement et traités à l'hôpital universitaire fédéral Alex-Ekwueme, à Abakaliki, dans l'État d'Ebonyi, au Nigéria. L'analyse statistique a été réalisée avec la version 26 du logiciel SPSS. Une valeur de P inférieure à 0,05 a été considérée comme statistiquement significative. RÉSULTATS: Un total de 189 patients ont présenté un cancer de la prostate ; cependant, seuls les 73 patients avec des données complètes ont été analysés. L'âge moyen des patients était de 71,48±8,16 ans. La durée médiane des symptômes avant la présentation était de 6 mois. La concentration moyenne d'antigène spécifique de la prostate (PSA) total était de 82,08±54,9 ng/mL. La durée moyenne entre la première visite et le diagnostic définitif était de 6,53±11,68 mois, avec une médiane de 1(1) mois. La durée médiane entre la visite et le traitement était de 3 mois, avec une moyenne de 9,71±13,4 mois. Aucune association n'a été observée entre l'occupation, le plus haut niveau d'éducation, les contraintes financières et les différents délais d'attente étudiés (P>0,05). CONCLUSION: Les délais d'attente pour la prise en charge du cancer de la prostate étaient anormalement prolongés dans cette étude ; les facteurs liés au patient n'ont pas influencé cette attente. MOTS-CLÉS: Cancer de la prostate, Délai d'attente, Délai, Diagnostic, Traitement.

Correlation between bladder wall thickness and uroflowmetry in West African patients with benign prostatic enlargement.

Background: Pressure flow urodynamic study remains the gold standard for the diagnosis of bladder outlet obstruction; however, their use is limited by their relative unavailability in our environment, cost, and invasiveness. Measurement of bladder wall thickness (BWT) by transabdominal ultrasonography is a promising tool that can be used to diagnose bladder outlet obstruction in our environment where pressure-flow urodynamic study is not readily available. Objective: The study aimed to correlate BWT with uroflowmetry and to establish a BWT cut-off in patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. Materials and Methods: This was a prospective one-year study of patients with LUTS due to benign prostatic enlargement. The patients were divided into obstructed and non-obstructed groups with Q- max of 10 ml/s serving as the cut-off value. Receiver Operator Curve (ROC) was used to evaluate the performance of BWT in diagnosing BOO. Statistical significance was set at P < 0.05. Results: The mean BWT and Q-max were 4.53 ± 2.70 mm and 15.06 ± 9.43 ml/s. There was a negative correlation between BWT and Q-max (r = -0.452, P = 0.000), Q-average (r = -0.336, P = 0.000), and voided volume (r = -0.228, P = 0.046). A BWT cut-off of 5.85 mm was found to be the best threshold to differentiate obstructed from non-obstructed patients with a sensitivity and specificity of 70 and 88.2 percent respectively. Conclusion: Bladder wall thickness showed an inverse relationship with maximum flow rate with high sensitivity and specificity. This non-invasive test can be used as a screening tool for BOO in our setting, where the pressure flow urodynamic study is not readily available.

Urologic Day Case Surgery at a Nigerian Tertiary Hospital: A 5-Year Experience.

BACKGROUND: Nowadays, the practice of day case surgery (DCS) is an attractive and appealing one with widespread acceptability because of numerous benefits. AIM: This study aimed at presenting our experience with urologic DCS in a tertiary healthcare center. PATIENTS AND METHODS: A 5-year review of all day-case urologic surgeries at our tertiary healthcare center was carried out. Data on patients' biodata including age and sex, diagnoses, indications and procedures performed, types of anesthesia, complications, admission and re-admission history were obtained from theatre records and patients' case notes. Data were analyzed using PASW Statistics version 18.0 and results presented in table and charts. RESULTS: A total number of 1277 of the 1825 urologic surgeries which took place during the study period were performed as day cases giving a proportion of 67.8%. The age range was 11 days to 94 years. The most commonly performed DCS are prostate biopsy, cystoscopy and varicocelectomy in 368 (28.8%), 165 (12.9%) and 163 (12.8%) patients respectively. Local anesthesia with or without sedation was the most commonly used in 981 (76.8%) cases. Twenty-four (1.9%) patients required unplanned admission for complications, 18 (1.4%), delayed completion of surgery, 4 (0.3%) and delayed recovery from anesthesia, 2 (0.16%). Three (0.2%) of these patients were re-admitted for management of sepsis following prostate biopsy. CONCLUSION: This study like numerous others demonstrated the feasibility, effectiveness and safety of DCS. To meet up with the global trends in DCS in Nigeria, there is need for investment in infrastructure and adoption of minimally invasive techniques to allow incorporation of more complex cases in the range of procedures offered as DCS.

An evaluation of usefulness of prostate specific antigen and digital rectal examination in the diagnosis of prostate cancer in an unscreened population:experience in a Nigerian teaching hospital.

OBJECTIVE: 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. PATIENTS, MATERIALS AND METHODS: A prospective study 168 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 > 4 ng/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. RESULTS: 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% CONCLUSION: 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.

Detection of prostate cancer: comparison of cancer detection rates of sextant and extended ten-core biopsy protocols.

AIMS AND OBJECTIVES: To compare the cancer detection rates of sextant and ten- core biopsy protocol amongst patients being evaluated for prostate cancer. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: We conclude that a ten-core prostate biopsy protocol significantly improves cancer detection and should be considered as the optimum biopsy protocol.

Is extended biopsy protocol justified in all patients with suspected prostate cancer?

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.

The value of percentage free prostate specific antigen (PSA) in the detection of prostate cancer among patients with intermediate levels of total PSA (4.0-10.0 ng/mL) in Nigeria.

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% (P < 0.05). 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.

Gross haematuria among adult Nigerians: current trend.

AIMS AND OBJECTIVES: 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. PATIENTS AND METHODS: 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. RESULTS: 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). CONCLUSION: 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.