Utility of prostate-specific antigen density and its correlation with Gleason grade groups: a hospital-based cross-sectional study among patients with prostate-related urinary symptoms at Bugando Medical Centre, Mwanza, Tanzania.

BACKGROUND: At Bugando Medical Centre, prostate cancer contributes to 39% of all cancers in male patients admitted to the Oncology department, and the majority have high Gleason grades. Although Prostate-specific antigen density (PSAD) has been shown to improve the diagnostic accuracy of prostate cancer and to triage patients for prostate biopsy, there is a significant variation across geographical locations. METHODS: A hospital-based cross-sectional study among patients with prostate-related urinary symptoms at Bugando Medical Centre, Mwanza, Tanzania. The study analyzed prostate-specific antigen levels, prostate volume, and total PSA using Maglumi 2000 and a computer system. Histopathological examination involved transrectal biopsy, TURP, and open prostatectomy. The optimal cutoff for PSA density was determined using the receiver operating characteristic curve. RESULTS: Of the 287 patients, the overall mean age of 71.2 (± 10.2) years. 99 (34.5%) participants were diagnosed with prostate cancer. The area under the curve for prostate-specific antigen density and PSA was 0.9094 (0.8761–0.9426) and 0.8932 (0.8569–0.9295), respectively. The PSAD optimal cut-off was 0.23ng/ml2, giving sensitivity of 86.9% and specificity of 82.4% for prostate cancer prediction. Using this cutoff reduces prostate biopsies by 54.5%. There was a weak positive correlation (Spearman’s rho (ρ) = 0.2456) between prostate-specific antigen density and Gleason grade groups. CONCLUSIONS: The correlation between PSAD and Gleason grade groups observed in this study suggests that higher PSAD is associated with more aggressive cancer. This makes PSAD a valuable tool in guiding biopsy decisions, risk stratification, and treatment planning in patients with prostate-related urinary symptoms.