Factors associated with high-grade prostate cancer detection at initial biopsy in patients attending Muhimbili National Hospital

Abstract

ABSTRACT Background: Prostate cancer (PCa) is a significant public health concern, particularly in the elderly male population. Detecting high-grade prostate cancer (HGPC) is crucial because it has a worse prognosis than low-grade PCa, necessitating aggressive treatment. Objective: This study investigated factors associated with the detection of high grade prostate cancer in patients undergoing initial biopsy at Muhimbili National Hospital (MNH), with a focus on the Tanzanian context. Methods: A retrospective cross-sectional analytical design was employed, encompassing adult males aged 40 years and older who underwent prostate biopsy at MNH. Demographic, clinical, and lifestyle factors were systematically assessed, and data on prostate-specific antigen (PSA) levels, digital rectal examination (DRE) findings, prostate ultrasound and biopsy results were recorded. A Chi-square test was conducted to analyse the associations between factors of interest and high grade prostate cancer (Gleason score ≥ 7). Multivariate analysis was employed to determine the independent factors associated with high-grade prostate cancer, controlling for confounding variables. A p value ≤ 0.05 was considered to indicate statistical significance. Results: A total of 260 participants who underwent prostate biopsy from October 2022 to March 2024 were included in this study. The majority were aged 60-79 years (72±9), married, and self-employed. Common comorbidities included hypertension (42.7%) and diabetes (8.1%), and a positive history of smoking was reported by 38.5% of patients. The main complaint was LUTS (61.5%), and 73.5% of the studied population had abnormal findings on digital rectal examination (DRE). The median PSA level was 81.6 ng/mL (0.096-2000), with 93.8% of patients having increased PSA levels. The proportion of HGPC among the studied population was 63.08%, with Gleason patterns 8 and 9 being the most prevalent (42.1% and 26.8%, respectively). Multivariate logistic regression analysis revealed significant predictors of HGPC, including a family history of prostate cancer (AOR = 8.45, p = 0.001), cigarette smoking (AOR = 2.797, p = 0.044), abnormal DRE findings (AOR = 36.897, p < 0.001), and a PSA-Density greater or equal to 0.15 (AOR = 10.39, p = 0.044). Conclusion: Family history of prostate cancer, cigarette smoking, abnormal DRE findings and a PSA-D greater or equal to 0.15 emerged as significant predictors of HGPC. Overall, these findings emphasize the need for individualized patient selection for prostate biopsy while targeting HGPC.