Relationship between interviewer-assisted international prostate symptom score and other objective measures of bladder outlet obstruction in Southeast Nigeria: a cross-sectional study.

Introduction: there are concerns that interviewer-assisted administration of the International Prostate Symptom Score (IPSS) may introduce bias to the extent that values obtained may not correlate with the more objective measures of bladder outlet obstruction (BOO) in benign prostate enlargement (BPE). This study aims to determine the relationship between interviewer-assisted IPSS and the more objective peak urine flow rate (Qmax) and postvoid residual urine volume (PVR) in men with lower urinary tract symptoms (LUTS) due to BPE in a low-resource setting. Methods: a cross-sectional study from July 2020 to June 2021. Using systematic random sampling, men ≥ 40 years old with LUTS attributable to uncomplicated BPE were recruited. Participants completed the English-language IPSS questionnaire with the needed assistance from the interviewer. Thereafter, the Qmax was assessed using uroflowmetry while PV and PVR were assessed using ultrasonography. Age, serum total prostate-specific antigen (tPSA), body mass index (BMI), and the highest level of formal education attained were determined. Multivariate logistic regression analysis was used to examine the relationship between these variables and IPSS. Results: in all, 170 men of mean age 63.7±9.9 years participated. The mean PV, PVR, and Qmax were 70.84±39.50 cm3, 77.66±69.30 cm3, and 20.25±9.70ml/s, respectively. Of these 170 participants, 134 (78.8%) attained formal education beyond the primary level. Increasing points of interviewer-assisted IPSS have a strong relationship with worsening self-perceived quality of life due to LUTS (r: 0.76; p= 0.001), but a rather weak relationship with decreasing Qmax (r: -0.40; p= 0.009) and increasing PVR (r: 0.49; p= 0.005). Higher formal education was associated with lower IPSS at presentation and was statistically significant (p = 0.004). There were no predictable relationships between IPSS and age, tPSA, PV, and BMI (p > 0.05). Conclusion: interviewer-assisted IPSS can be relied upon, but with some caution, in low-resource, low-formal education settings to give clinical information consistent with the objective measures of BOO.

Predicting Gleason score using the initial serum total prostate-specific antigen in Black men with symptomatic prostate adenocarcinoma in Nigeria.

BACKGROUND: Men of Black African descent are known to have the highest incidence of prostate cancer. The disease is also more aggressive in this group possibly due to biologically more aggressive tumor or late presentation. Currently, serum prostate-specific antigen (PSA) assay plays a significant role in making the diagnosis of prostate cancer. However, the obtained value of serum PSA may not directly relate with the Gleason score (GS), a measure of tumor aggression in prostate cancer. This study explores the relationship between serum total PSA at presentation (iPSA) and GS. PATIENTS AND METHODS: The iPSA of patients with histologically confirmed prostate cancer was compared with the obtained GS of the prostate biopsy specimens. The age of the patients at presentation and the prostate volumes were also analyzed with respect to the iPSA and GS. The data were analyzed retrospectively using IBM SPSS Version 20. Pearson correlation was used for numeric variables, whereas Fisher's exact test was used for categorical variables. Significance was set at P≤0.05. RESULTS: There were 205 patients from January 2010 to November 2013 who satisfied the inclusion criteria. iPSA as well as age at presentation and prostate volume were not found to significantly correlate with the primary Gleason grade, the secondary Gleason grade, or the GS. However, the presence of distant metastasis was identified to significantly correlate positively with GS. CONCLUSION: GS may not be confidently predicted by the iPSA. Higher iPSA does not correlate with higher GS and vice versa.

Prostate-specific antigen density values among patients with symptomatic prostatic enlargement in Nigeria.

BACKGROUND: This study aims to estimate the prostate-specific antigen density (PSAD) cutoff level for detecting prostate cancer (CAP) in Nigerian men with "grey zone PSA" (4-10 ng/ml) and normal digital rectal examination findings. We addressed this research question: Is the international PSAD cutoff of 0.15 ideal for detecting CAP in our symptomatic patients with "grey zone PSA?" AIM: To estimate the prostate-specific antigen density (PSAD) cutoff level for detecting CAP in Nigerian men with "grey zone PSA" (4-10 ng/ml) and normal digital rectal examination findings. DESIGN: Prospective. SETTING: A tertiary medical center in Enugu, Nigeria. PARTICIPANTS: Two hundred and fifty-four men with either benign prostatic hyperplasia (BPH) or CAP were recruited. INTERVENTION: Patients with PSA above 4 ng/ml or abnormal digital rectal examination or hypoechoic lesion in the prostate were biopsied. OUTCOME MEASURES: PSAD and histology report of BPH or CAP. RESULTS: Ninety-seven patients had CAP while 157 had benign prostatic hyperplasia (BPH). Seventy-two patients had their serum PSA value within the range of 4.0 and 10 ng/ml. PSAD cutoff level to detect CAP was 0.04 (sensitivity 95.88 %; specificity 28.7 %). CONCLUSIONS: The PSAD cutoff level generated for Nigerian men in this study is 0.04 which is relatively different from international consensus. This PSAD cutoff level has a positive correlation with histology and could detect patients with CAP who have "grey zone PSA."

Trainee resident participation in health research in a resource-constrained setting in south-eastern Nigeria: perspectives, issues and challenges. A cross-sectional survey of three residency training centres.

BACKGROUND: The participation of trainers and trainees in health research is critical to advance medical science. Overcoming barriers and enhancing incentives are essential to sustain a research culture and extend the frontiers of medical education. In this study, we investigated the roles of individual and system factors influencing trainee resident participation in health research in Enugu, south-eastern Nigeria. METHODS: This cross-sectional survey of trainee residents was conducted across three residency training centres in Enugu, Nigeria, between February and March, 2010. The number and speciality distribution of trainee residents were determined from personnel records at each centre. A 19-item questionnaire was used to record demographic characteristics, research training/experience, and attitudes toward and perceived barriers to health research. Data were analysed to yield frequencies, percentages and proportions. Values of p<0.05 were considered significant. RESULTS: The response rate was 93.2%. The respondents (n=136) comprised 109 males and 27 females. Their mean±standard deviation age was 35.8±5.6 years (range: 25-53 years). Participation in research was significantly associated with previous research training [odds ratio (OR): 2.90; 95% confidence interval (CI): 1.35-6.25, p=0.003, ß=22.57], previous research participation (OR: 2.21; 95% CI: 0.94-5.29, p=0.047, ß=22.53) and research publication (OR: 2.63; 95% CI: 1.00-7.06, p=0.03, ß=22.57). Attitude towards research was significantly influenced by perceived usefulness of research in patient care (OR: 7.10; 95% CI: 3.33-15.13, p=0.001), job promotion (OR: 8.97; 95% CI: 4.12-19.53, p=0.001) and better understanding of disease (OR: 21.37; 95% CI: 8.71-54.44, p=0.001). Time constraints (OR: 0.06; 95% CI=0.025-0.14, p=0.001), funding (OR: 0.028; 95% CI: 0.008-0.10, p=0.001) and mentorship (OR: 0.086; 95% CI: 0.36-0.21, p=0.001) were significant barriers to research participation. CONCLUSIONS: System and individual factors are significant incentives to research participation, while system-derived factors are significant barriers. Pre-residency research, dedicated research time, adequate research funding and commensurate research mentorship rewards are instructive. Prospective longitudinal studies are warranted to confirm these findings.