Feasibility and Diagnostic Yield of Blind Transrectal Digital Core Biopsy for Prostate Cancer in a Resource Limited Setting: A Cross Sectional Study Faisabilité et rendement diagnostique de la biopsie prostatique transrectale digitale à l’aveugle en milieu à ressources limitées : étude transversale

Résumé

Introduction: Prostate cancer imposes a significant burden in resource-limited settings where advanced imaging like transrectal ultrasound or MRI is unavailable, necessitating evaluation of simpler biopsy techniques. This study aimed to assess the feasibility, diagnostic yield, safety profile, and prognostic utility of serum PSA in blind transrectal digital-guided core prostate biopsy performed at a low resource setting. The primary research question was whether this technique provides clinically meaningful histopathological confirmation and risk stratification in high-prevalence, late-presentation populations.​

Matérial and methods
This prospective cross‑sectional study included 46 consecutive men (mean age 71 years) who underwent blind digital transrectal core biopsy at HEAL Africa Hospital (April 2023–September 2025). Histopathology categorized specimens as benign or malignant. Continuous variables were summarized as mean ± standard deviation, categorical variables as frequencies and percentages. Because PSA values were non‑normally distributed, non‑parametric analyses were applied, including Spearman’s correlation and receiver operating characteristic (ROC) curve analysis to assess PSA discrimination (AUC, optimal cutoff via Youden index). Statistical significance was set at p < 0.05.​

Results: Adenocarcinoma was confirmed in 69.6% (32/46), with high-grade tumors (Gleason ≥8) in 46.8%. PSA strongly associated with cancer diagnosis (rₛ =0.782, p<0.001) and Gleason score (rₛ =0.423, p=0.016). ROC analysis yielded AUC 0.953 (95% CI 0.895-1.000), optimal cutoff 49.8 ng/mL (sensitivity 75%, specificity 100%). Complications were low (6.5%, mild hematuria/rectal bleeding); repeat biopsy was needed in 4.3%.​

Conclusion: Blind digital transrectal prostate biopsy demonstrates feasibility and safety in resource‑limited environments. When combined with prostate‑specific antigen (PSA) testing, this approach provides robust diagnostic and prognostic utility. These findings highlight a pragmatic pathway toward equitable access to prostate cancer diagnosis in settings where imaging modalities are unavailable