Prostate Cancer Screening in a Healthy Population Cohort in Eastern Nepal: an Explanatory Trial Study

Background: Prostate cancer features a substantial incidence and mortality burden, similarly to breast cancer,and it ranks among the top ten specific causes of death in males.
Objective: To explore the situation of prostatecancer in a healthy population cohort in Eastern Nepal. Materials and
Methods: This study was conducted inthe Department of General Surgery at B. P. Koirala Institute of Health Sciences, Dharan, Nepal from July 2010to June 2011. Males above 50 years visiting the Surgical Outpatient Department in BPKIHS were enrolled in thestudy and screening camps were organized in four Teaching District Hospitals of BPKIHS, all in Eastern Nepal.Digital rectal examination (DRE) was conducted by trained professionals after collecting blood for assessmentof serum prostatic specific antigen (PSA). Trucut biopsies were performed for all individuals with abnormalPSA/DRE findings.
Results: A total of 1,521 males more than 50 years of age were assessed and screened aftermeeting the inclusion criteria. The vast majority of individuals, 1,452 (96.2%), had PSA ≤4.0 ng/ml. AbnormalPSA (>4 ng/ml) was found in 58 (3.8%). Abnormal DRE was found in 26 (1.72%). DRE and PSA were bothabnormal in 26 (1.72%) individuals. On the basis of raised PSA or abnormal DRE 58 (3.84%) individuals weresubjected to digitally guided trucut biopsy. Biopsy report revealed benign prostatic hyperplasia in 47 (3.11%)and adenocarcinoma prostate in 11 (0.73%). The specificity of DRE was 66.0%with a sensitivity of 90.9% anda positive predictive value of 38.5%. The sensitivity of PSA more than 4ng/ml in detecting carcinoma prostatewas 100% and the positive predictive value for serum PSA was 19.0%
Conclusions: The overall cancer detectionrate in this study was 0.73% and those detected were locally advanced. Larger community-based studies arehighly warranted specially among high-risk groups.