Introduction: The introduction of prostate specific antigen (PSA) and progress in transrectal ultrasound and ultrasound-guided prostatic biopsies have allowed considerable progress in the diagnosis of prostate cancer. However prostate cancer is still usually diagnosed at an advanced stage in Tunisia.
Methods: We prospectively evaluated the prevalence of localized prostate cancer in the population of a Tunisian centre during a screening programme. This study included all men consulting for a urological problem between January 1998 and June 2001, between the ages of 50 and 75 years with an estimated life expectancy of at least 10 years. Screening consisted of digital rectal examination (DRE) and total and free PSA assay. Systematic ultrasound-guided prostatic biopsies (9 biopsies) were performed in the case of a suspicious DRE, total PSA between 4 and 20 ng/ml and a free PSA/total PSA ratio less than 25%.
Results: 642 patients were screened. 521 patients (81%) had a PSA less than 4 ng/ml, 23 had a suspicious DRE and PSA less than 4 ng/ml. No cancer was detected by prostatic biopsies. 92 patients (14%) had a PSA between 4 and 20 ng/ml and 44 of them had a free PSA/total PSA ratio less than 25%. Prostatic biopsies were performed in 59 of these 92 patients with PSA between 4 and 20 ng/ml and revealed 18 cancers: 3 stage pN+ and 15 stage pN0, including 1 stage pT3 and 14 stage pT2 after radical prostatectomy. 14 cancers detected in a population of 642 men (2.2%) were therefore stage pT2. 29 patients (4.5%) had a PSA higher than 20 ng/ml. All underwent surgical prostatic disobstruction demonstrating adenocarcinoma. A total of 47 cancers (7.3%) were therefore detected.
Conclusion: Early individualized screening is possible in Tunisia and allows the detection of localized prostate cancer in 77% of patients with PSA less than 20 ng/ml. The use of prostatic biopsies in the case of abnormal screening tests improves the management of prostate cancer in Tunisia.
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