Prostate cancer screening parameters in a high-risk African-Caribbean population

Objectives To estimate the prostate cancer screening parameters in a population-based study of African-Caribbean men from the Island of Tobago. Methods A total of 2582 men aged 40 to 79 years (50% of all Tobago men in this age group) were screened using both serum prostate-specific antigen (PSA) and digital rectal examination (DRE). Men with an elevated PSA level (4 ng/mL or greater) or abnormal DRE findings were referred for ultrasound-guided sextant biopsy. Results The screening results for one or both tests were abnormal in 32% of men. The prevalence of prostate cancer was 10.7 of 100 screened men. The positive predictive value for PSA was 56% compared with 39% for DRE. The positive predictive value for PSA ranged from 6% for those aged 40 to 49 years to 59% for those aged 70 to 79 years. The sensitivity was 71% and the specificity 86% for DRE. The sensitivity for PSA was 80%. The sensitivity was low among men aged 40 to 49 years (20%) and 50 to 59 years (66%). The specificity for PSA declined across age groups from 98% for those aged 40 to 49 years to 70% for those 70 to 79 years. Conclusions The screening parameters in this African-Caribbean population were similar to the sparse data available from other populations of African descent. The screening was highly efficacious, with a positive predictive value of 56% for an elevated PSA level and 40% for an elevated PSA level and/or abnormal DRE findings.