title: Prostate cancer diagnosis in a resource-poor setting: the changing role of digital rectal examination.
abstract: We undertook this study in order to determine the current role of digital rectal examination (DRE) in the diagnosis of prostate cancer in a resource-poor setting. The diagnosis of prostate cancer has been revolutionized by the introduction of prostate-specific antigen (PSA), transrectal ultrasound (TRUS) for biopsy guidance and more efficient biopsy equipment, but they are not readily available in most developing countries. This is a prospective study of 131 patients with suspected prostate cancer based on clinical presentation, DRE and elevated PSA. The presence or absence of cancer was confirmed by biopsy and histologic examination. Patients with screen- or incidentally-detected prostate cancer were excluded. The most common symptom was the development of lower urinary tract symptoms (LUTS). All patients had abnormal DRE and indurated prostate was the most frequent finding (50%). The mean PSA was 33.9 ng/mL: of the 131 patients, 80 (61.1%) had a malignant histology following biopsy, 47 (35.9%) were benign and four (3.0%) were prostate intraepithelial neoplasia (PIN). The low specificity of DRE in the diagnosis of prostate cancer requires that it should be combined with other diagnostic modalities such as PSA and TRUS-guided prostate biopsy. Thus government and health-care providers in resource-poor countries must strive to make these facilities available in order to improve prostate cancer diagnosis.
authors.affiliation: Ahmadu Bello University Teaching Hospital - Surgery, Shika, Zaria, Kaduna State 810001, Nigeria. darm313@yahoo.com
authors.forename: Muhammed
authors.initials: M
authors.lastname: Ahmed
mesh_terms: D000369:Aged, 80 and over; D003906:Developing Countries; D051517:Digital Rectal Examination / Q000706:statistics & numerical data*; D006295:Health Resources; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D011203:Poverty; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000032:analysis; D019048:Prostatic Intraepithelial Neoplasia / Q000175:diagnosis / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology
chemical_list: D017430:Prostate-Specific Antigen