Prognostic use of Prostate Specific Antigen, Some Renal Indices and Uric Acid in the Diagnosis of Prostate Cancer and Renal Impairment at Urology Clinic Federal Medical Centre Lokoja, Nigeria

Aims: Improved diagnosis of prostate cancer has led to increasing life expectancy in adult men. The use of PSA as the current practice for screening and treatment has become a key prognostic factor in the management of PCa. This study was designed to evaluate the prognostic use of serum PSA, creatinine, urea, protein and uric acid in PCa subjects with or without renal impairment.

Study Design: The study was a prospective study conducted between March and September 2016 at federal Medical Centre Lokoja, Kogi State, Nigeria.

Methods: One hundred and ten adult men aged 51 - 70 years were conveniently recruited for the study. Diagnosis was based on biopsy, PSA, Cr/U and UA results obtained, and grouped as (A) PCa subjects with RI (35), (B) PCa subjects without RI (35) and 40 apparently healthy men (Controls) which is regarded as group (C). Blood samples were collected and analyzed for PSA and renal indices using ELISA and colorimetric methods respectively.

Results: The result showed that serum tPSA, fPSA, cPSA, %fPSA, creatinine, urea and uric acid were significantly higher while total protein was significantly lower in PCa subjects with RI compared with controls (P<.05). Similar results were obtained in PCa without RI compared with controls except for urea (P=.001respectively). However, tPSA, fPSA, cPSA were significantly lower while creatinine, urea and uric acid were significantly higher in Pca with RI compared with the corresponding values in PCa without RI (P<.05). The correlation between cPSA, creatinine and urea showed association between PCa and RI. ROC showed that tPSA and cPSA had significantly higher diagnostic performance than fPSA and % fPSA in the prediction of PCa associated with RI while Creatinine, urea and uric acid had significantly higher diagnostic accuracy in the prediction of RI associated with PCa within the age range of 50-61 than 61-70 years.

Conclusions: Increased serum uric acid level observed in RI subjects suggests decreased excretion of uric acid by the kidney. ROC analysis shows significant evidence that tPSA and cPSA have higher predictive value for PCa with or without RI while creatinine, urea and uric acid have higher predictive efficacy for RI in PCa subjects. Adult men from 50 years are recommended for early screening for PDs to minimize progression to RI.