Elsevier

Urology

Volume 63, Issue 4, April 2004, Pages 737-741
Urology

Adult urology
Prostate cancer screening parameters in a high-risk African-Caribbean population

https://doi.org/10.1016/j.urology.2003.10.064Get rights and content

Abstract

Objectives

To estimate the prostate cancer screening parameters in a population-based study of African-Caribbean men from the Island of Tobago.

Methods

A total of 2582 men aged 40 to 79 years (50% of all Tobago men in this age group) were screened using both serum prostate-specific antigen (PSA) and digital rectal examination (DRE). Men with an elevated PSA level (4 ng/mL or greater) or abnormal DRE findings were referred for ultrasound-guided sextant biopsy.

Results

The screening results for one or both tests were abnormal in 32% of men. The prevalence of prostate cancer was 10.7 of 100 screened men. The positive predictive value for PSA was 56% compared with 39% for DRE. The positive predictive value for PSA ranged from 6% for those aged 40 to 49 years to 59% for those aged 70 to 79 years. The sensitivity was 71% and the specificity 86% for DRE. The sensitivity for PSA was 80%. The sensitivity was low among men aged 40 to 49 years (20%) and 50 to 59 years (66%). The specificity for PSA declined across age groups from 98% for those aged 40 to 49 years to 70% for those 70 to 79 years.

Conclusions

The screening parameters in this African-Caribbean population were similar to the sparse data available from other populations of African descent. The screening was highly efficacious, with a positive predictive value of 56% for an elevated PSA level and 40% for an elevated PSA level and/or abnormal DRE findings.

Section snippets

Material and methods

The Tobago Prostate Survey is an ongoing prostate cancer screening study on the Caribbean Island of Tobago, population 46,435, according to the 1990 census.12 The target recruitment population for this study was all men 40 to 79 years old (5121 men). In 1990, the population of Tobago was 92% African descent, 4.5% mixed, 2% East Indian, 0.4% white, and 1% other.12

This report on the first prostate cancer screening program in Tobago included men recruited between September 1997 and December 2002.

Results

This report describes the first 2582 men, aged 40 to 79 years (mean ± SD 55.9 ± 10.6), who underwent screening with both serum PSA determination and DRE. Of these 2582 men, 92.0% reported three or four grandparents of African descent and 5.4% reported mixed ancestry with one or two grandparents of African descent. The distribution of serum PSA levels by age group in those with and without prostate cancer is presented in Table I.

The screening results for each test separately and combined, by

Comment

This study screened more than one half of the men aged 40 to 79 years residing on the Island of Tobago. The age-specific rates of abnormal screening results and the PPV of an abnormal screening result for prostate cancer were much greater in this high-risk population compared with an early screening study in a U.S. population by Richie et al.15 (predominantly white: 92% white, 3% African American, and 5% other). This reflects, in part, the threefold greater screening-detected prevalence rate of

Conclusions

The screening parameters in this African-Caribbean population were similar to the sparse data available from other populations of African descent. Screening was highly efficacious, with a PPV of 56% for an elevated PSA level and 40% for an elevated PSA level and/or abnormal DRE findings.

Cited by (0)

This study was supported, in part, by funding or in-kind services from the Division of Health and Social Services, Tobago House of Assembly, University of Pittsburgh Cancer Institute, contract DAMD 17-99-1-9015, U.S. Department of Defense, and grant R01 CA84950, U.S. National Cancer Institute.

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