Introduction The prostate is the major accessory sex organ in males. It’s a major source of morbidity in males as the age gets over 40 years especially benign prostatic hyperplasia and prostate cancer which is the second leading cause of cancer deaths in men. In Uganda, Prostate cancer is the most common cancer of men and there has been a major increase in incidence. Serum PSA levels can be used to screen men at risk of prostate cancer. Prostate volume (PV) increases with age at different rates throughout a man’s lifetime, and in the course of different prostatic diseases. Therefore, knowledge of PV and serum PSA level is imperative for understanding the natural history of prostatic diseases, and as criteria for diagnostic and therapeutic decision-making. Thus this study was intended to demonstrate the relationship between prostate sonographic findings and serum PSA levels among asymptomatic Ugandan males attending Mulago Hospital. Objective To determine the relationship between prostate sonographic findings and PSA levels among asymptomatic adult males attending Mulago Hospital Methodology This was a descriptive cross sectional study among 277 adult males above 30 years without lower urinary tract symptoms (LUTS) attending Mulago hospital. Blood samples for serum PSA were drawn and a transrectal ultrasound done to determine prostate volume, presence of prostate nodules and other prostate lesions. Data was entered in to the computer using Microsoft Excel and analyzed using GraphPad Prism for Mac. Results Overall, the median (range, 95% confidence interval of median) serum PSA level was 1 (0.1-16; 95% CI: 1-2) ng/ml. Two hundred and seventeen (78.3%) participants had serum PSA levels of 4ng/ml or less, 49 (17.8%) had levels between 4 and 10ng/ml and 11(3.9%) had levels above 10ng/ml. Overall, the median (range, 95% confidence interval of median) sonographic prostate volume was 26 (13-99; 95% CI: 26-29) mls. Both serum PSA levels and prostate volume progressively increased with age from 0.9ng/ml and 22mls in the 30-39 year age group to 7ng/ml and 38mls in the 60-69 year age group respectively. The correlation coefficient (spearman’s correlation coefficient, ρ) between participants’ serum PSA levels and prostate volumes was 0.27. One hundred and thirty (47%) participants had prostatic nodules. One hundred (77%) participants had features of benign nodules while 23% had suspicious nodules for prostate cancer. The median (range) PSA in participants with nodules was 2(0.1 - 16)ng/ml and for those without nodules was 1.1(0.1 - 8)ng/ml. The median (range) PSA density in participants with nodules was 0.07(0.0 - 1)ng/ml/ml and for those without nodules was 0.05(0.0 - 2)ng/ml/ml. Conclusion; Majority (78.3%) of the participants had serum PSA levels less than or equal to 4ng/ml however the highest PSA value was 16ng/ml. The median sonographic prostate volume was 26mls with 95% confidence interval of median of 26-29mls. There was a weak direct correlation between serum PSA levels and prostate volume (correlation coefficient of 0.27). One hundred thirty (47%) of the participants had prostatic nodules and of that, 23% had features of suspicious nodules for cancer of prostate. There was a great overlap in the serum PSA levels of those with nodules and those without. There was a great overlap in PSA densities of those with nodules and those without. Hence both serum PSA and PSA density cannot predict the presence or absence of prostatic nodules. Recommendation; Serum PSA levels should be interpreted together with age and prostate sonographic findings. The median PSA values and median prostate volumes calculated for asymptomatic men may serve as a baseline in future studies. A larger study is required to establish reference values for age specific serum PSA levels and prostate volumes in Uganda. Further research should be done to correlate prostatic nodules in asymptomatic males with histopathological findings.

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