Modalities of prostate specific antigen testing in Gauteng clinics and hospitals, South Africa

• Main Author: Maphayi, Mpho Reginah
• Format: Others
• Language: en
• Published: 2018
• Online Access: https://hdl.handle.net/10539/25288

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree in Master of Medicine (Chemical Pathology). Johannesburg, 2018. === Background: The use of prostate specific antigen (PSA) in screening for prostate cancer remains controversial. However, in developing countries mortality from prostate cancer remains high due to lack of screening facilities such as PSA testing. Prostate specific antigen testing could be beneficial in reducing advanced prostate cancer and mortality in developing countries like South Africa. The Prostate Cancer Foundation of South Africa has issued guidelines on the use of PSA in prostate cancer screening, diagnosis and management, but we do not know how this test is used in our healthcare facilities. Aims and objectives: To describe modalities of PSA testing in screening and diagnosis of prostate cancer in terms of number of PSA test requests, patient demographic characteristics, type of health care facility (clinic versus hospital), prostate biopsy uptake and PSA level. Methods: This was a descriptive retrospective study of PSA tests done at the National Health Laboratory Services laboratory at Charlotte Maxeke Johannesburg Academic Hospital from January 2013 to December 2013. Results: 17 498 subjects had PSA tests. Of these 13 795 (79%) were done in Black African men (BA) while 3703 (21%)) in other racial groups (Others). More requests (62%) were from clinics versus than from hospitals (38%). The mean age for Black Africans (55.5 years SD (±13.3 years) was significantly lower than that of Others (62.9 years (±12.6 years, p<0.005), and median PSA level was significantly higher in Black African men from age 60 and above compared to Others (1.79 versus 1.53 μg/L, p<0.001). More Black Africans aged 60 and above had PSA level above age specific reference interval than others of the same age category (33% versus 26%, p<0.001). Only 17% of all men had a PSA above 4.00 μg/L which is the cut-off used by the National Health Laboratory Services. Of the four hundred and twenty-three men who underwent prostate biopsy, 213 (50%) had cancer. Fewer prostate biopsies were done in Black Africans than Others (2% vs. 4 % p=0.01), although Black African men were more likely to be diagnosed with prostate cancer on biopsy than Others (54% vs. 43%, p=0.03). Conclusion: PSA testing is a common practice in our healthcare facilities. The numbers of PSA tests done differ by age and race of patients. Black African men had lower biopsy uptake even though they were likely to be diagnosed with prostate cancer on biopsy. === LG2018