RESUMO
Objectives: To assess and compare the diagnostic accuracy of prostate-specific antigen (PSA) and digital rectal examination (DRE) in the diagnosis of prostate cancer. Materials and Methods: It was a prospective, comparative study carried out over a period of 14 months at the University of Benin Teaching Hospital, Benin City. It involved male patients ≥50 years who presented at the urology clinic with lower urinary tract symptoms (due to prostatic disease), PSA > 4 ng/mL and or abnormal DRE findings. They had serum total PSA determined. Patients were recruited for prostate biopsy and samples sent for histopathological assessment. Histopathology was determined by a histopathologist dedicated to the study. Using a researcher-administered, structured proforma, data were collected, collated and subjected to statistical analysis for assessment and comparative analysis of the diagnostic accuracy of PSA and DRE. Results: The study involved 94 patients; they were all Nigerians. The age range of the study population was 50-85 years, with a mean age of 70.4 ± 8.6 years. Most (89.4%) of the patients were exposed to formal education. PSA of the study population ranged between 2.5 and 840 ng/mL. For patients with carcinoma of the prostate (CaP), median PSA value was 79.2 ng/mL, whereas patients with benign prostatic disease had a median PSA value of 16.0 ng/mL. The difference in median PSA value between the two groups was statistically significant (P < 0.001). In this study, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of PSA was 97.2%, 12.1%, 40.7%, 87.5% and 44.7%, respectively. However, a sensitivity, specificity, PPV, NPV and diagnostic accuracy of DRE was 88.9%, 70.7%, 65.3%, 91.1% and 77.7%, respectively. Combination of PSA and DRE had sensitivity, specificity, PPV, NPV and diagnostic accuracy of 91.7%, 91.4%, 86.8%, 94.6% and 91.5%, respectively. In this study, 36 (38.3%) patients had CaP whereas 57 (60.6%) patients had benign prostatic disease and 1 (1.1%) patient had high-grade prostatic intraepithelial neoplasia. Conclusion: The study revealed a low specificity, high sensitivity and low diagnostic accuracy of PSA in diagnosis of CaP. However, sensitivity, specificity, and diagnostic accuracy of DRE were high but not sufficient in diagnosis of CaP. A combination of PSA and DRE had a higher sensitivity, specificity and diagnostic accuracy in diagnosis of prostate cancer.
RESUMO
Background: The periodic determination of the degree to which coroner's postmortems done for medicolegal purpose turns out to be natural death is desirable because of its usefulness to health administrators in making policies that may ultimately help in focusing on the prevention/management of the causes of natural death at that particular point in time. Objective: The objective of the study was to determine the causes of natural death by a retrospective analysis of coroner's postmortem cases carried out on patients ages 19 years and above who died from natural causes. Materials and Methods: A 3-year period, retrospective postmortem study was carried out at the Department of Anatomic Pathology, University of Benin Teaching Hospital on 530 medicolegal postmortem cases ages 19 and above who died from natural causes. Results: Natural deaths were observed in 530 cases of medicolegal postmortems. Their age ranged from 19 years to 104 years with a mean age and standard deviation of 52.82 ± 16.71 years. Cardiovascular system diseases were the most common causes of natural deaths with hypertensive heart disease being the most common underlining cause. Infections and diseases of the respiratory, gastrointestinal system/hepatic, central nervous and endocrine systems were also noteworthy. Conclusions: Most causes of natural deaths were in the middle ages with the noncommunicable diseases (NCDs) accounting for a significant proportion. To reduce premature death from NCDs by 2030, the World Health Organization (WHO) is promoting its prevention and management. It is our desire that our health administrators would adopt this WHO model incorporating postmortem-based data for planning of medical services.
