Abstract
Prostate cancer (PCa) has become the most prevalent cancer among males in Nigeria, and similar to other black populations, Nigerian men present with more advanced disease at an earlier age than in several other ethnic groups. In this unscreened, high-risk group, the reference range for early detection and diagnosis as well as risk factors need to be determined through large-scale screening. Over 4 years, 1124 previously unscreened men between 40 and 85 years of age were screened at free community health programmes for PCa, using the common parameters of prostate-specific antigen (PSA) plus digital rectal examination (DRE). We thereby assessed the practicality and importance of screening. Consent was obtained, demographic data obtained, PSA measured using qualitative laboratory kits, and DRE performed by surgeons.We found that the number of men attending and consenting to screening increases from year to year. Of 40–85-year-old men, 85.4% consented, of whom 33.3% (a third) and 60% were 51–60 years old and 51–65 years, respectively. While 11.5% of men had PSA >4 ng/ml, 31.45% showed abnormal DRE. Of the men who took the PSA test, 79.2% also consented to the DRE, of whom 5.8% had combined abnormal DRE and PSA >4 ng/ml.Our findings suggest that Nigerian men are a willing group for screening by both the PSA and DRE with the positive response to calls for health screening and interest in prostate health. The finding of PSA >4 ng/ml in 11.15% of this population reveals the need for greater awareness and measures to increase early detection. However, the value and validity of established PSA reference ranges and cutoff of ‘normal’ still need to be established. Screening is very important to better define the PCa prevalence and characteristics in our population; otherwise political and economic circumstances will ensure that men still present late with aggressive PCa.
Highlights
With regards to prostate health, the Nigerian male population is an unscreened group
Our findings suggest that Nigerian men are a willing group for screening by both the prostate-specific antigen (PSA) and digital rectal examination (DRE) with the positive response to calls for health screening and interest in prostate health
Rebbeck et al [1] observed that lower rates of prostate cancer (PCa) in Africa may in part reflect a lower probability of PCa detection than in countries like the US where prostate-specific antigen (PSA) and digital rectal examination (DRE) screening have been more widely used
Summary
With regards to prostate health, the Nigerian male population is an unscreened group. The literature shows that prostate cancer (PCa) is on the rise among Nigerian men just as is being noted in other men of African descent in developing as well as in developed countries. It is often aggressive and discovered at later stages. PCa is thought to be more prevalent among AA than African men. Is this really correct [2]? Little is known about the value of the current major marker for PCa, the PSA, and its applicability and practicability for screening in the Nigerian male populace. ‘Normal’ and age-specific ranges of PSA have not been determined
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