TITLE:
Total PSA as a Predictor of Bone, Lymph Node, and Visceral Metastasis in Patients with Prostate Cancer: A Cameroonian Retrospective Study
AUTHORS:
Cyril Kamadjou, Divine Enorou Eyongeta, Annie Kameni Wadeu, Marcel Tchagna, Zacharie Sando, Herve Edouard Moby Mpah
KEYWORDS:
Prostatic Neoplasms, Prostate-Specific Antigen, Neoplasm Metastasis, Bone Neoplasms, Lymphatic Neoplasms, Resource-Limited Settings
JOURNAL NAME:
Open Journal of Urology,
Vol.16 No.10,
October
23,
2026
ABSTRACT: Background: Metastatic prostate cancer is frequently diagnosed in resource-limited settings, where the cost and limited availability of staging investigations may delay appropriate management. This study assessed the ability of serum prostate-specific antigen (PSA) to predict metastasis among patients with prostate cancer treated at a urological center in Douala, Cameroon. Methods: We retrospectively reviewed the clinical records of 216 patients with prostate cancer from 2020 to 2025. Demographic, clinical, PSA, and metastatic-status data were analyzed using R version 4.5.1. Metastases were categorized into overall, bony, visceral, or ganglionic. Receiver operating characteristic (ROC) curve analyses were performed to estimate PSA thresholds for predicting overall, bony, and ganglionic metastases. Diagnostic performance was summarized using the area under the curve (AUC), sensitivity, specificity, positive predictive value, and negative predictive value. Results: The participants had a mean age of 65.76 ± 8.13 years. Metastases were present in 76 patients (35.19%), including 41, 3, and 68 with bony, visceral, and ganglionic metastases, respectively. The median PSA titer was significantly higher among patients with metastases, and the proportion of metastatic disease progressively increased with increasing PSA concentration. For overall metastasis, the AUC was 0.9600 (95% CI: 0.9287 - 0.9796), with an optimal threshold of 54.585 ng/mL, yielding sensitivity, specificity, positive predictive, and negative predictive values of 93.42%, 87.14%, 79.78%, and 96.06%, respectively. For bone metastasis, the AUC was 0.9438 (95% CI: 0.9008 - 0.9756), with a threshold of 150.70 ng/mL. For ganglionic metastasis, the AUC was 0.9317 (95% CI: 0.8943 - 0.9617), with a threshold value of 54.585 ng/mL. Conclusion: PSA demonstrated excellent discrimination for metastatic disease in this Cameroonian cohort. The identified thresholds may support risk-adapted prioritization of staging investigations in resource-constrained settings, but extra validation is needed before routine adoption.