Nomogram for predicting the probability of the positive outcome of prostate biopsies among Ghanaian men

Introduction and objectives: Several existing models have been developed to predict positive prostate biopsy among men undergoing evaluation for prostate cancer (PCa). However, most of these models have come from industrialized countries. We therefore, developed a prostate disease nomogram model to provide a basis for predicting a prostate biopsy outcome by correlating clinical indicators and diagnostic parameters among Ghanaian men.Subjects and methods: The study was a hospital-based cross-sectional prospective one which was under- taken at the Department of Surgery (Urology Unit) Komfo Anokye Teaching Hospital (KATH) from December, 2014 to March, 2016. In all a total of 241 patients suspected of having a prostate disorder due based on an abnormal digital rectal examination (DRE) findings and, or elevated prostate specific antigen (PSA) level underwent Trans-Rectal Ultrasonography (TRUS) guided biopsy of the prostate. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Age, prostatespecific antigen (PSA), digital rectal examination (DRE) status, prostate specific antigen density (PSAD), history of alcohol consumption and history of smoking findings were included in the analysis. Two nomogram models were developed that were based on these independent predictors to estimate the probability of a positive initial prostate biopsy. Receiver-operating characteristic curves (ROC) were used to assess the accuracy of using the nomograms and PSA and PSAD levels for predicting positive a prostate biopsy outcome. Results: Prostate cancer was diagnosed in 63 out of 241 patients (26.1%). Benign prostatic hyperplasia was diagnosed in 172 (71.4%) of patients and the remaining 6 patients (2.48%) had chronic inflammation. Significantly elevated levels of PSA and PSAD were observed among patients with PCa compared to patients without PCa (p < 0.05). Furthermore, it was observed that age, DRE, PSA, PSAD, history of smoking, and history of alcohol consumption were significantly independent predictors (p < 0.05) of prostate cancer. The area under the receiver operating characteristic curve (AUC) of nomogram I and II were 87.3 and 84.8 respectively which were greater than that of total PSA (AUC = 75.8) and PSAD (AUC = 77.8) alone for predicting a positive initial prostate biopsy. Conclusion: We conclude that, nomograms offer a better and accurate assessment for predicting a positive outcome of prostate biopsies than the use of traditional tools of PSA, DRE and PSAD alone

Acute and chronic urine retention among adults at the urology section of the Accident and Emergency Unit of Komfo Anokye Teaching Hospital, Kumasi, Ghana

Introduction: The causes and management of acute urine retention (AUR) and chronic urine retention (CUR) are different and varied in both gender and age. Urine retention has been well studied among males worldwide, while data on urine retention among women are sparse. This study aimed at determining the causes and management of AUR and CUR among adults at the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Subjects and methods: A prospective study was conducted during 8 months period. The study was carried out at the Urology and Accident and Emergency Units of KATH. A complete work-up to establish the cause of urine retention preceded data collection. The subject's demographic data, causes and management of urine retention with outcomes were recorded on data sheet. Data was analyzed using Stata version 12.0. Results: Two hundred and six subjects were enrolled in the study. There were 198 men and 8 women with mean ages of 62.8 ± 16.8 and 55.4 ± 18.4 years respectively. The prevalence of AUR and CUR in the population were 172 (83.5%) and 34 (16.5%) respectively. Among the males 169 (85.4%) presented with AUR while 29 (14.6%) presented with CUR. The causes of AUR or CUR in men were: benign prostatic enlargement (BPE) 115 (58.1%), urethral stricture 29 (14.7%), carcinoma of the prostate 26 (13.1%), traumatic urethral injury 26 (13.1%) and others 1%. AUR was found in 3 (37.5%) and CUR in 5 (62.5%) of the women studied. Two women each had bladder carcinoma and neurogenic bladder respectively. One each of utero-vaginal prolapse, bladder stones, urethral tumour and urethral trauma respectively were also found. Urinary tract infection occurred in 20 (9.7%) and renal insufficiency in 32 (16.5.0%) of respondents. The mean volume of urine drained on catheterization was 800.0 ± 161.7 ml. The immediate treatment was by urethral catheterization in 146 (70.9%) and suprapubic cystostomy in 60 (29.1%). The definitive treatment for the underlying causes of urine retention was varied. Conclusions: Acute and chronic urine retention is not uncommon, but credible baseline data on this condition is nonexistent at KATH, Kumasi. Urine retention found among the participants was mainly AUR. Men were the most affected with benign prostatic enlargement, being the leading cause. Among women, acute or chronic urine retention was caused mainly by bladder cancer and neurogenic bladder. Initial and definitive management were varied between causes, gender and age

Nomogram for predicting the probability of the positive outcome of prostate biopsies among Ghanaian men

Introduction and objectives: Several existing models have been developed to predict positive prostate biopsy among men undergoing evaluation for prostate cancer (PCa). However, most of these models have come from industrialized countries. We therefore, developed a prostate disease nomogram model to provide a basis for predicting a prostate biopsy outcome by correlating clinical indicators and diagnostic parameters among Ghanaian men. Subjects and methods: The study was a hospital-based cross-sectional prospective one which was undertaken at the Department of Surgery (Urology Unit) Komfo Anokye Teaching Hospital (KATH) from December, 2014 to March, 2016. In all a total of 241 patients suspected of having a prostate disorder due based on an abnormal digital rectal examination (DRE) findings and, or elevated prostate specific antigen (PSA) level underwent Trans-Rectal Ultrasonography (TRUS) guided biopsy of the prostate. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Age, prostate-specific antigen (PSA), digital rectal examination (DRE) status, prostate specific antigen density (PSAD), history of alcohol consumption and history of smoking findings were included in the analysis. Two nomogram models were developed that were based on these independent predictors to estimate the probability of a positive initial prostate biopsy. Receiver-operating characteristic curves (ROC) were used to assess the accuracy of using the nomograms and PSA and PSAD levels for predicting positive a prostate biopsy outcome. Results: Prostate cancer was diagnosed in 63 out of 241 patients (26.1%). Benign prostatic hyperplasia was diagnosed in 172 (71.4%) of patients and the remaining 6 patients (2.48%) had chronic inflammation. Significantly elevated levels of PSA and PSAD were observed among patients with PCa compared to patients without PCa (p < 0.05). Furthermore, it was observed that age, DRE, PSA, PSAD, history of smoking, and history of alcohol consumption were significantly independent predictors (p < 0.05) of prostate cancer. The area under the receiver operating characteristic curve (AUC) of nomogram I and II were 87.3 and 84.8 respectively which were greater than that of total PSA (AUC = 75.8) and PSAD (AUC = 77.8) alone for predicting a positive initial prostate biopsy Conclusion: We conclude that, nomograms offer a better and accurate assessment for predicting a positive outcome of prostate biopsies than the use of traditional tools of PSA, DRE and PSAD alone. Keywords: Nomogram, Prostate biopsy, Prostate specific antigen (PSA), Prostate specific antigen density (PSAD