Role of transrectal ultrasound and prostate-specific antigen density in assessment of clinically suspicious prostate cancer

Background: Prostate cancer (CaP) is a major health concern with rising incidence especially in Black African populations. Digital rectal examination (DRE), transrectal ultrasound scan (TRUS) of the prostate, and prostate-specific antigen density (PSAD) values are useful adjuncts in early diagnosis of CaP. Objective: This study was aimed at evaluating the role of TRUS and PSAD and their correlation with histopathologic findings in patients with DRE features suspicious of CaP. Patients and Methods: This research was a descriptive cross-sectional study of 100 male patients with suspected CaP based on DRE and elevated prostate-specific antigen (PSA) values recruited from the urology clinic and wards of the hospital during 2018–2019. All patients had clinical evaluation, biodata documentation, and grayscale TRUS while PSA values were determined using immunoassay method. PSAD was calculated by dividing the PSA value by the TRUS prostate volume. P ≤ 0.05 at 95% confidence interval was considered significant. Results: The mean age of patients was 66.70 ± 9.60 years with age range of 44–90 years. TRUS features of heterogeneous echotexture (n = 37; 37%), regular outline (n = 73; 73%), and intact capsule (n = 77; 77%) showed the highest frequencies. TRUS alone (P = 0.189, 0.214 and 0.265 for echopattern, outline, and capsular integrity, respectively) was not statistically significant in differentiating between benignity and malignancy. Total mean PSAD was 0.63 ± 0.32 ng/ml/cm3 while the highest mean PSAD was observed in patients with irregular glandular outline (0.74 ± 0.17 ng/ml/cm3) and in those with solitary hypoechoic nodules (0.73 ± 0.61 ng/ml/cm3). There was statistically significant correlation between PSAD values and outcome of prostate biopsy (P = 0.031). Conclusion: PSAD showed a positive correlation with outcome of prostate biopsy as well as greater predictability of CaP than TRUS which was not statistically significant in differentiating between benignity and malignancy.