Frequency of prostate cancer in patients with abnormal prostate-specific antigen (4–10 ng/mL) and normal digital rectal examination of prostate

Objective: To determine the frequency of prostate cancer (PCa) in patients with normal digital rectal examination (DRE) and prostate-specific antigen (PSA) levels of 4–10 ng/mL. Material and Methods: This cross-sectional study was conducted at the Sindh Institute of Urology and Transplantation (SIUT), Karachi, from May to November 2023. Eighty patients aged 40–70 years with normal DRE, 4–10 ng/mL PSA levels, and free/total PSA ≥25% were enrolled. Transrectal ultrasound-guided prostate biopsy was performed for histopathological confirmation. Data on demographics, clinical parameters, and biopsy results were analyzed using SPSS v20.0. Results: The cohort’s mean age was Mean (SD) 54.8 (7.2) years, with 55% residing in urban areas. Prostate cancer was found in 11.3% (9/80) of patients. Urban residency (9/44 urban vs. 0/36 rural, p=0.003) and positive family history of cancer (4/9 vs. 0/71, p=0.001) were strongly associated with PCa. Mean PSA levels (Mean (SD) 5.5 (1.1) ng/mL) and prostate volume (Mean (SD) 33.1 (3.8) mL) aligned with benign prostatic hyperplasia. Body mass index (Mean (SD) 27.5 (4.7) kg/m²) and symptom duration (Mean (SD) 9.8 (5.3) days) showed no significant correlation. Conclusion: In this Pakistani cohort, 11.3% of male individuals with PSA 4–10 ng/mL and normal DRE were diagnosed with prostate cancer, lower than global averages but clinically significant. Urban residency and familial cancer history emerged as critical risk markers. These findings advocate for personalized screening protocols and cautious biopsy use in resource-limited settings. Keywords: Prostate-specific antigen, Prostatic neoplasms, Digital rectal examination, Biopsy, Risk factors