Uptake of Prostate Biopsy and Its Predictors Among Patients Previously Confirmed To Have Elevated Prostate-Specific Antigen Levels At Kyabirwa Surgical Center, Jinja City: A cross-sectional study

Uptake of Prostate Biopsy and Its Predictors Among Patients Previously Confirmed To Have Elevated Prostate-Specific Antigen Levels At Kyabirwa Surgical Center, Jinja City: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Uptake of Prostate Biopsy and Its Predictors Among Patients Previously Confirmed To Have Elevated Prostate-Specific Antigen Levels At Kyabirwa Surgical Center, Jinja City: A cross-sectional study ELTON GEORGE WANDIRA, PENNINAH ASIIMWE, JOB NANYIRI, ANNAH TINKA AINEMBABAZI, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9220746/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 11 You are reading this latest preprint version Abstract Purpose: To assess prostate biopsy uptake and its predictors among patients previously found to have elevated Prostate-Specific Antigen results at the Kyabirwa Surgical Center. Method: An analytical cross-sectional design was employed to study male patients with elevated PSA levels (> 10 ng/mL) at the Kyabirwa Surgical Center. They were consecutively sampled, located in their areas of residence, and engaged in structured interviews. Data were collected and analyzed descriptively using SPSS version 26, with a log-binomial model for relationship analysis. Results: The proportion of patients with elevated PSA levels at the Kyabirwa Surgical Center (KSC) who underwent prostate biopsy was 55.8%, the majority of whom underwent biopsy at the center (72.4%). Perceived good health and the ability to perform biopsy at any time lowered the prevalence of uptake.However, educating patients about prostate health, the cost of a prostate biopsy, the mean PSA results, the importance of a biopsy, how it is performed by healthcare providers at KSC, and being followed up by healthcare workers at KSC to determine compliance with the instructions to perform a biopsy increases biopsy uptake. Conclusion: The uptake of prostate biopsy among patients previously found to have elevated Prostate-Specific Antigen levels at the Kyabirwa Surgical Center is fair; only half of them go ahead to undergo biopsy. Antagonists of prostate biopsy uptake are patient-related, while all protagonists are institutional and specifically related to post-test patient education. Introduction A biopsy is a diagnostic procedure that involves removing a small sample of tissue or cells from a specific site in the body for microscopic examination (Johns Hopkins University, 2024). Biopsies are especially crucial for staging potentially metastatic diseases, notably cancers, and for providing confirmatory diagnoses (Mavrogenis et al., 2024 ). Some cancers are associated with greater global concern than others, including prostate cancer, the 4th most commonly diagnosed cancer worldwide, with 1.4 million new cases annually (Anu et al., 2023; Bray et al., 2024 ; American Cancer Society, 2024 ; World Cancer Research Fund, 2024 ). Prostate cancer affects only men and is the most common cancer among men in 118 countries worldwide (James et al., 2024 ; Bray et al., 2024 ). Deaths from prostate cancer result from complications that are directly related to cancer stage and complications of late-stage treatment (stage III or IV) (Angulo, 2024 ; Claaßen et al., 2024 ). Therefore, early diagnosis of prostate cancer is essential for better prognosis and treatment outcomes (James et al., 2024 ), which require initial screening with the prostate-specific antigen (PSA) test. When elevated PSA levels (exceeding 10ng/ml) are detected, prostate biopsy is performed, which involves sampling tissue from the prostate gland with a needle and microscopic examination of cancer cells (Deivasigamani et al., 2023 ; Zambon et al., 2023 ; Mate et al., 2023 ; The Johns Hopkins University, 2024). Prostate biopsy is considered the gold standard for diagnosing prostate cancer (Devetzis, Kum, Popert, 2021 ; Novara et al., 2023 ), given its high accuracy and minimal side effects (Mate et al., 2023 ). Common complications include hematospermia (Borghesi et al., 2017 ) and acute urinary retention (Borghesi et al., 2017 ), which occur in less than 6% of patients, making it very safe. Its diagnostic accuracy and sensitivity range from 94 to 100% (Dirks et al., 2023 ; Ariizumi et al., 2022 ; Hsiao et al., 2022 ). However, late diagnosis of prostate cancer remains common worldwide (James et al., 2024 ), even among men with a history of elevated PSA levels. Although data on the uptake of biopsies among men with elevated PSA levels are limited, the available evidence by Aly et al. ( 2019 ) indicates a range of 21.7%–47.7%. At the Kyabirwa Surgical Center (KSC), cases of men with elevated PSA levels who do not undergo prostate biopsies have been noted, but not quantified. Although approximately 40% of prostate cancer screening tests at the KSC revealed elevated PSA levels, it was hypothesized that some of these patients did not undergo biopsy. The exact proportion remains unknown; only the total number of patients who underwent biopsy at KSC is known, and not the total number of men with elevated PSA levels who were eligible for biopsy. This gap not only exists at KSC but also worldwide; numerous studies have assessed prostate cancer screening rates based on PSA test uptake (Mirzaei-Alavijeh et al., 2020 ; Okyere et al., 2023 ; Ngowi et al., 2024 ; Vetterlein et al., 2018 ; Leong et al., 2020 ; Lewis-Thames et al., 2021 ), including Uganda (Mwebembezi et al., 2023 ; Ekwan et al., 2023 ). Nevertheless, very few studies have assessed the uptake of biopsies among men with elevated PSA (> 10ng/ml), with only a few studies by Zeliadt et al. ( 2012 ) and Aly et al. ( 2019 ) conducted in Sweden. This is a palpable research gap that should be addressed to prevent late-stage diagnosis of prostate cancer and increase five-year survival rates among patients who receive related treatment. Materials and methods Study area and design This study was conducted at the Kyabirwa Surgical Center (KSC), the only standalone ambulatory surgical center in Uganda, located in Jinja City, specifically in Kyabirwa Village, Budondo Sub-County. The facility commenced operations in 2019, implying that it has been providing ambulatory surgical care for approximately six years (as of the end of 2025), with the range of care including laparoscopic and laparotomy ambulatory surgeries and minor surgeries such as excisions. In addition to major and minor surgical care, KSC provides a wide range of diagnostic services, including ultrasound scans, colonoscopies, endoscopies, biopsies, and prostate-specific antigen tests (PSA). However, during the time that the center provided PSA tests to men, a trend of some men not subsequently undergoing prostate biopsies, despite having elevated PSA levels detected at the center, has been noted. Even so, some of them might have undergone biopsies at other facilities, but the proportion was unknown and thus, the possible predictors of their prostate biopsy uptake. To conduct the study, an analytical cross-sectional design was most suitable, based on the fact that the study involved the assessment of the level of uptake of prostate biopsy among all men who had previously detected elevated PSA levels. Such quantification requires a study population to be categorized into numerator and denominator populations, which is only possible with a cross-sectional design (Alexander et al., 2015 a; Cummings, 2013 ; Mann, 2012 ; Wang and Cheng, 2020 ). Second, the study involved the collection of all data (both exposure and outcome) at the same time for each respondent and did not follow them up, which is also possible with a cross-sectional design. Third, two of the study objectives required an analysis of the associations between exposure and the outcome variable, which was also possible with an analytical cross-sectional design (Alexander et al., 2015 a; Cummings, 2013 ; Mann, 2012 ; Wang and Cheng, 2020 ). Study population and size The study targeted men who underwent a prostate-specific antigen test at the Kyabirwa Surgical Center between 2022 and 2025, given that the center has been providing a diagnostic test since 2022 and that it is within that period that cases of non-uptake of prostate biopsies have been rapidly noted. However, among these men, the study population of interest was those who had a PSA that was equal to or greater than 10ng/ml, detected at Kyabirwa Surgical Center. These men were categorized as having an elevated PSA level and hence had to undergo a prostate biopsy thereafter to allow for the possible early detection of prostate cancer and its prompt and more effective treatment. The study will include men who are available for a 40-minute-long interview and can sustain one such interview without any health-related complaints. The study included only men who were seen by clinicians at KSC following the detection of an elevated PSA level, given that it is such patients who had possibly been influenced by institutional characteristics at KSC, and hence, in a position to give responses related to institutional characteristics. The study excluded men previously found to have elevated PSA levels, but who had contraindications for prostate biopsy, including perianal disorders, surgical absence of the rectum, significant immunosuppression, or an infectious disease. The sample size of men required for this study was initially calculated using the formula by Daniel (1999), since 242 men with elevated PSA levels had been identified at KSC, between 2022 and 2025, with a population size of less than 10,000. The formula is given by n = X.N / X + N, which is true when X is 384, as provided by the Kish–Leslie formula (1995), where N is the population size. Using this formula, the initial sample size, with a population size of 242, was 148. However, upon commencement of the sampling process (described in the next section), it was found that most of the men screened for potential inclusion succumbed to prostate cancer were not reachable via telephone or were too morbid to be included in an interview. This left only 52 men who could be practically studied; given such an accessible sample, they were all included. Sampling procedures The Kyabirwa Surgical Center maintains a database of all patients who receive surgical and/or diagnostic care services such as the prostate-specific antigen test. Therefore, in liaison with the responsible staff at the KSC, the principal investigator requested a list of all men who underwent PSA testing at the KSC between 2022 and 2024. This list was filtered out along with the PSA result of each man so that at the subsequent stage of sampling, consecutive sampling was used to further screen men with elevated PSA levels. They constituted the final sampling frame, in which consecutive sampling was used to sample all 52 men who met the inclusion criteria of the study and were available for interviews. Consecutive sampling is a non-random sampling technique that was considered the most suitable sampling technique for this study because it is suitable for small population sizes. Consecutive sampling is the least biased of all non-random sampling methods, as it includes all eligible respondents (Polit and Beck, 2017 ). Therefore, with consecutive sampling, it was possible to include all 52 men, thus maximizing the available population size for men with elevated PSA levels. Each of them was called, assessed for eligibility, briefed about the study, and then looked for and located in their respective communities of residence by the data collection team where they were interviewed. Data collection techniques Structured interviews were used to collect all self-reported data required for this study, that is, all data that could be validated by the patients. Structured interviews solicit closed-ended responses, which can be quantified during analysis; therefore, since the study took an analytical cross-sectional approach, these interviews sufficed. However, this study also involved document reviews as a second data collection method. Document review was used to verify claims of previous uptake of a prostate biopsy, given that each patient who underwent biopsy was ideally given a medical report to that effect. Thus, each patient who reported having undergone biopsy was requested to provide documentary proof. The medical documents were verified for authenticity by examining the details of the service-providing institution, including their names, serial numbers, and dates. If one reported not having their records or having lost them, the interviewers engaged in extensive probing to verify the claim of having had a biopsy performed. All responses were captured using a structured questionnaire that was uploaded to the Kobo Collect Toolbox. The questionnaire was designed with parts I to IV arranged chronologically, with the study objectives starting with socio-demographic characteristics. Data management and analysis Data captured using the Kobo Collect toolbox were first downloaded into an Excel spreadsheet and then exported to SPSS version 26. Once exported, data cleaning was performed to ensure that all the captured data were cleaned, well-coded, and appropriately entered. Any rectifications were made at this point, and then sample frequency distributions were run to determine whether all data per variable entered were well captured/coded and distributed. This was followed by an analysis of the frequency distributions of each variable, especially the level of uptake of prostate cancer biopsy, as its outcome was a valid percentage. Cross-tabulation distributions were then analyzed between each of the exposure variables and the outcome (uptake of prostate cancer biopsy), after which those with no null integers were subjected to bivariable analysis. Bivariate analysis was performed using a generalized linear model, the appropriateness of which was determined based on the magnitude of the outcome (Martinez et al., 2017 ; Nijem et al., 2005 ; Barros and Hirakata, 2003 ). Based on the findings of this study, the magnitude of the outcome was common (> 10%); therefore, a log-binomial model was used first at the bivariate level. At that level, all variables with p-values less than 0.2 were considered eligible for multivariable analysis, during which adjustment for confounders was made in a single model. After adjusting for confounders, all variables that remained significant at the 5% alpha level were considered factors associated with prostate biopsy uptake and were reported in terms of adjusted prevalence ratios (aPR), along with their confidence intervals. Ethical considerations This study was submitted to the Hospice Africa Uganda Research Ethics Committee (HAUREC) for institutional review and approval, with subsequent approval provided under the number HAU-2024-146 . Further approval to conduct this study in Uganda was obtained from the Uganda National Council of Science and Technology ( SS3886ES) . This was followed by solicitation and receipt of permission to access patient data at the Kyabirwa Surgical Center and conduct the study. Permission was sought from the administration of the center, and each patient sampled was included in the study only if they provided informed consent to be respondents, following the orientation on what the study was about, during the consent process. Each had their data digitally captured and kept on a secure, passworded platform that was installed on the principal investigator’s tablet. This meant that the data were kept confidential. All data were anonymized. The names of the patients were used only during the sampling process and were not included in the study. All interviews were conducted in private with full certainty that no third party would listen to the interview between the interviewer and patient. Human Ethics and Consent to Participate declaration Study respondents were informed about the voluntary nature of their participation in this study, that they were free to decline participation at their will, and that they could expect no consequences. All participants provided informed consent for this study. Clinical trial number Not applicable. Accordance statement The protocol was approved by Hospice Africa Uganda Research Ethics Committee (HAUREC) in accordance with the guidelines of the Helsinki Declaration 2024, (World Medical Association, 2024) and the current Uganda National Council of Science and Technology (UNCST) guidelines (UNCST, 2025). Results Sociodemographic characteristics of the respondents Table 1 Sociodemographic characteristics of the men who were sampled and interviewed Variable n(%) Age 50–70 26 (50.0) 70–90 years 26(50.0) Marital status Cohabiting 9(60.0) Widowed / Separated 6 (40.0) Formally educated Yes 45 (86.5) No 7 (13.5) Level of education Primary 26 (57.8) Secondary 13 (28.9) Post-secondary (Institute) 6 (13.3) Currently employed Yes 25 (48.1) No 27 (51.9) District of residence Jinja 17 (32.7) Luuka 4 (7.7) Mpigi 3(5.8) Buyende 1(1.9) Kamuli 9(17.3) Mayuge 4(7.7) Bugiri 2(3.8) Buikwe 4(7.7) Tororo 1(1.9) Kayunga 2(3.8) Iganga 3(5.8) Bugweri 1(1.9) Kaliro 1(1.9) Equal proportions of the patients were aged between 50 and 70 years (26, 50.0%) and between 70 and 90 years (26, 50.0%). The majority were cohabiting (9, 60.0%) and formally educated (45, 86.5%), although more than half of those who were formally educated were educated to the primary level (26, 57.8%). More than half of the patients who participated in this study were not currently employed (27, 51.9%), and almost two-thirds were residents of Jinja City (17, 32.7%). Biopsy uptake Table 1 Assessment of biopsy uptake characteristics among patients found to have elevated PSA at Kyabirwa Surgical Centre Variable n(%) Up took prostate biopsy Up taken 29 (55.8)* Not 23 (44.2) Facility from which the biopsy was done At Kyabirwa Surgical Center 21 (72.4) Jinja RRH 3 (10.3) Mengo Hospital 2 (6.9) Mulago NRH 1 (3.4) Old Kampala Hospital 1 (3.4) Mbale RRH 1 (3.4) If Kyabirwa Surgical Center, the time taken until doing a biopsy, following the reception of PSA results Less than 2 weeks 11 (52.4) 3 to 4 weeks 7 (33.3) More than 4 weeks 3 (14.3) If not at Kyabirwa surgical center, the time taken until doing a biopsy, following the reception of PSA results Less than 1 year 4 (50.0) More than 1 year 4 (50.0) *Frequency and percentage showing prostate biopsy uptake The majority of the patients had undergone prostate biopsy (55.8%), and almost three-quarters of them underwent biopsy at the Kyabirwa Surgical Center (21, 72.4%). Among the patients who underwent biopsy at KSC, more than half underwent the test within 2 weeks of being told to have it done (11, 52.4%). However, half of those who had undergone biopsy elsewhere took months to do so, following the reception of an elevated PSA result (4, 50.0%). Predictors of biopsy uptake Table 3 Bivariate and multivariate analysis of the predictors among patients previously confirmed to have elevated Prostate-Specific Antigen levels at Kyabirwa Surgical Center, Jinja city Variable Prostate biopsy uptake Crude estimates Adjusted estimates Up taken Not up taken cPR (95% CI) P value aPR (95% CI) P value I think I am still healthy; I will have the biopsy done anytime. Agree 4 (26.7%) 11(73.3%) 0.368 (0.154–0.878) 0.024 0.363 (0.152–0.866) 0.022 Undecided 4 (50.0%) 4(50.0%) 0.690 (0.333–1.431) 0.319 0.673 (0.324–1.401) 0.290 Disagree 21(72.4%) 8(27.6%) 1.000 1.000 Healthcare workers at KSC educated patients about prostate health. Yes 22(75.9%) 7 (24.1%) 2.129 (1.117–4.060) 0.022 2.150 (1.157–3.995) 0.015 No 7(30.4%) 16(69.6%) 1.000 1.000 Healthcare workers at KSC educated patients about what the PSA results meant. Yes 22 (75.9%) 7(24.1%) 2.493 (1.300–4.780) 0.006 2.404 (1.264–4.572) 0.007 No 7(30.4%) 16(69.6%) 1.000 1.000 Healthcare workers at KSC educated patients about the importance of a biopsy and how it is done. Yes 21(72.4%) 8(27.6%) 2.082 (1.139–3.805) 0.017 2.413 (1.348–4.317) 0.003 No 8(34.8%) 15(65.2%) 1.000 1.000 Healthcare workers at KSC told the patient about the cost of a prostate biopsy. Yes 21(72.4%) 8(27.6%) 2.082 (1.139–3.805) 0.017 2.120 (1.159–3.878) 0.015 No 8(34.8%) 15(65.2%) 1.000 1.000 Healthcare workers at KSC followed up on the patient's instruction to do a biopsy. Yes 15 (71.4%) 6(28.6%) 1.582 (0.986 − 2.538) 0.057 1.603 (1.074–2.394) 0.021 No 14 (45.2%) 17 (54.8%) 1.000 1.000 Table 3 shows the predictors of biopsy uptake among patients previously confirmed to have elevated Prostate-Specific Antigen levels at the Kyabirwa Surgical Center in Jinja City. Six predictors were identified, of which one was an intrapersonal predictor and five were institutional predictors. Biopsy uptake was 74% lower among patients who thought that they were still healthy and could undergo biopsy at any time (aPR = 0.363, 95% CI = 0.152–0.866, p = 0.022) than among those who perceived that they were not healthy. Biopsy uptake was twice as high among patients who were educated about prostate health by healthcare workers at KSC (aPR = 2.150, 95% CI = 1.157–3.995, p = 0.015) than among those who were not educated about prostate health. It was also twice as high among patients who were educated about the PSA results (aPR = 2.404, 95% CI = 1.264–4.572, p = 0.007) and those who were educated about the importance of a biopsy and how it was performed (aPR = 2.413, 95% CI = 1.348–4.317, p = 0.003) than among those who were not educated. A high biopsy uptake prevalence was also observed among patients who were informed about the cost of prostate biopsy (aPR = 2.120, 95% CI = 1.159–3.878, p = 0.015) and those who were followed up by healthcare workers at KSC to determine compliance with the instructions to perform a biopsy (aPR = 1.603, 95% CI = 1.074–2.394, p = 0.021). Discussion This study established that the level of uptake of prostate biopsy among men eligible for it, following diagnosis of an elevated PSA level at Kyabirwa Surgical Center, is fair; approximately 56% of those men underwent biopsy. This translates to about half of all such men, which leaves half of them as non-takers of the definitive test for prostate cancer and at risk of being later diagnosed with that disease at a late stage (Chen et al., 2025 ; Frånlund et al., 2018 ). That is, irrespective of the fact that elevated PSA levels do not necessarily increase risk for cancer development due to the low specificity of PSA tests (Leal et al., 2018 ), which puts between 10 and 30% of patients with high PSA values at real risk for developing the disease (David and Leslie, 2025). The proportion of patients who might have developed prostate cancer notwithstanding, the fact remains that some of those who did not undergo biopsy since 2022 most likely developed the disease despite the window for possible detection at an early stage. This assertion could be substantiated by the finding that a significant proportion of patients who had been screened out of the KSC database actually succumbed to prostate cancer. Thus, the suboptimal level of uptake of prostate biopsy was indeed a problem among men referred to have it performed elsewhere or at KSC. Although there have been very few explicit assessments of prostate biopsy uptake levels among men with elevated PSA levels, there is high certainty that the problem is global. As mentioned earlier, there has been significant interest in prostate cancer screening using the PSA test in most previous studies. The level of screening uptake reported in previous studies was low, as reported by Leapman et al. ( 2022 ) (36.5%) in the United States, Ruan et al. ( 2024 ) (17.9%), Mirzaei-Alavijeh et al. ( 2020 ) (16.9%), Bello et al. ( 2019 ) in Nigeria (7.1%), Ojewola et al. ( 2017 ) (10.2%), Okyere et al. ( 2023 ) (4.4%), and Mwebembezi et al. ( 2023 ) (3.3%) in Uganda. The main difference between these previous findings and those revealed by this study is that the respondents in this study were men who had already undergone PSA and interacted with healthcare providers. This made them more likely to have comparatively better health-seeking behaviors, which explained their higher level of biopsy uptake (55.8%). Nonetheless, this was still suboptimal, although men who underwent biopsy had some characteristics that could be capitalized in the future to ensure higher uptake. All these characteristics were institutional in nature and related to patient-provider interaction and/or healthcare worker behavior in general, consistent with the findings of Mwebembezi et al. ( 2023 ), Tripathy et al. (2018), Yadav et al. ( 2021 ), Tripathy et al. (2018), and Bhoo-Pathy et al. ( 2019 ). We found that patients who received education on prostate health from healthcare workers at the KSC compared to those who did not receive such education. This finding relates to what is called patient activation, which is the increase in knowledge, skills, and confidence a patient has in managing their own health (Mosen et al., 2007 ), simply by educating them about a specific aspect of their health, such as prostate health. Prostate health education includes explaining the functions of the prostate gland, maintaining prostate health, signs of deterioration, and common complications, such as enlargement and cancer, and how to prevent these through screening. Providing this information to patients with elevated PSA levels is sufficient to improve their health literacy (Jones et al., 2021 ; Rao et al., 2022 ; Song and Shin, 2020 ; Soroya et al., 2023 ; Graffegna et al., 2017), increase their activation, and make them more likely to change their behavior. In this study, such behavioral changes refer to proceeding with prostate biopsy, and this remains true when patients are educated about what PSA results mean. This explains why the rate of biopsy uptake was still twice as high among patients who understood PSA results. These patients learn what an elevated PSA level signifies and the importance of a confirmatory diagnostic test for potential prostate cancer. We also found that the prevalence of prostate biopsy uptake was twice as high among patients who were educated about the importance of a biopsy and how it was performed compared with those who were not educated about it. Such education has the same effect of increasing patient activation; in addition, it comes with a complementary effect of allaying fears that are usually associated with having a biopsy performed. A biopsy is one of the most renowned antagonists of its uptake (Mndzebele & Mogale, 2015; Young et al., 2018 ; Opondo et al., 2022 ; Abuadas et al., 2015 ; Hejase et al., 2024 ; Ngowi et al., 2024 ; Muliira et al., 2017 ; Annan et al., 2019 ). It can be significantly allayed through demystification of any concerns and misconceptions that a patient may have, and an explanation of the procedure is given with emphasis on its generally low pain experience, leading to an uninhibited choice to undergo the biopsy. The fear of a biopsy can include fear of the pain associated with that biopsy and the high cost of the procedure, especially to the rural poor to which KSC typically provides care. Thus, if the education a patient receives also covers issues related to how much it would cost them to have it done, especially at the KSC, where the costs are subsidized, the potential cost barrier to uptake would be significantly minimized, paving the way for uptake. This explains why a higher biopsy uptake prevalence was also registered among patients who were informed about the cost of prostate biopsy. However, education about biopsy, its cost, and procedures may not be an end in itself; its effectiveness can be augmented when supplemented with follow-up calls made by healthcare workers. Patient follow-up ensures that the attitudinal and behavioral change patterns of a patient following education are monitored for further reinforcement, if necessary, especially if no biopsy uptake has occurred. Thus, patient follow-up can reinforce patient activation and guarantee uptake of a biopsy, which explains the finding that patients who were followed up by healthcare workers at the KSC to determine compliance with the instructions to perform a biopsy had a 60% higher prevalence of biopsy uptake than those who were not followed up. While five of the six significant predictors of prostate biopsy uptake increased uptake, the sixth predictor identified reduced uptake and was the perception of being healthy. The findings indicated that the uptake of biopsy was 74% lower among patients who thought that they were still healthy and could undergo biopsy at any time compared to those who perceived that they were not healthy. This finding relates to low perceived risk of developing prostate cancer, which has been previously reported to bar screening service uptake in previous studies as well (Opondo et al., 2022 ; Abuadas et al., 2015 ). This is because, if one has an elevated PSA test result but still thinks they are physically healthy, they find no reason to go ahead and have a confirmatory diagnosis of possible prostate cancer. Limitations While the study included all men who met the eligibility criteria, most of those with elevated PSA volumes between 2022 and 2025 were not accessible, which might have led to a type 1 error. Second, while we had a criterion that excluded men who had contraindications for prostate biopsy screening, it was not possible to definitively verify most of these contraindications during the community survey. Self-reports were relied upon in those few cases, implying that there could have been some underestimation of biopsy uptake caused by the exclusion of men who could have been eligible for the study. In this case, probing was used as a countermeasure to minimize erroneous exclusions. Conclusion The uptake of prostate biopsy among patients previously found to have elevated Prostate-Specific Antigen levels at the Kyabirwa Surgical Center is fair; only half of them go ahead to undergo biopsy. Therefore, half of all men found to be eligible for prostate cancer biopsy at the center do not have that biopsy performed, at least not at the KSC. Only a few of them have done so at other facilities, further emphasizing the fact that prostate cancer screening behavior is poor among men who are urged to undergo screening via biopsy by the KSC staff. Prostate cancer-related mortality among men potentially diagnosed with the disease at KSC will continue to be a challenge despite the status quo being maintained, even though KSC has the capacity to provide preventive health promotion services. To augment prostate cancer biopsy uptake among men, KSC administration must strengthen its patient-provider interaction quality, especially for men with elevated PSA levels. A facility policy should be made for all men found to have such test outcomes to receive sufficient education on issues related to prostate health, what a biopsy is, how it is done, and its cost, as such educational points have been found to increase patient activation. This should be in addition to incorporating risk education into such interactions, tailored to increase prostate cancer risk perceptions among all men who are eligible for biopsy. Declarations Availability of Data and Materials The datasets used and/or analyzed during this study are available from the corresponding author on reasonable request. Conflict of interest statement The authors declare no conflict of interest. Funding The authors declare that this study was not funded. References Abuadas MH, Petro-Nustas W, Albikawi ZF. Predictors of Participation in Prostate Cancer Screening among Older Men in Jordan. Asian Pac J Cancer Prev . 2015; 16(13): 5377–5383. DOI: https://doi.org/10.7314/APJCP.2015.16.13.5377 Alexander L, Lopes B, Richetti-Masterson K, Yeatts KR. (2015) Cross-Sectional Studies. In: Vol. Second Edition. ERIC Notebook. Durham, NC: Department of Epidemiology at the UNC Gillings School of Global Public Health Aly, M., Clements, M., Weibull, C. 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Ojewola RW, Oridota ES, Balogun OS, Ogundare EO, Alabi TO, Banjo OO, Laoye A, Adetunmbi B, Adebayo BO, Oluyombo R. Knowledge, attitudes and screening practices regarding prostatic diseases among men older than 40 years: a population-based study in Southwest Nigeria. Pan Afr Med J. 2017;27:151. Okyere, J., Ayebeng, C., Owusu, B. A., Ankomahene, B., & Dickson, K. S. (2023). Prostate cancer screening uptake in Kenya: An analysis of the demographic and health survey. Journal of Cancer Policy , 37 , 100427. https://doi.org/10.1016/j.jcpo.2023.100427 Opondo, C. O., Onyango, P. O., & Asweto, C. O. (2022). Effect of Perceived Self-Vulnerability on Prostate Cancer Screening Uptake and Associated Factors: A Cross-Sectional Study of Public Health Facilities in Western Kenya. Annals of Global Health , 88 (1), 12. https://doi.org/10.5334/aogh.3064 Lan L, Luo Y, Zhou M, et al. Comparison of diagnostic accuracy of thyroid cancer with ultrasound-guided fine-needle aspiration and core-needle biopsy: a systematic review and meta-analysis.  Front Endocrinol (Lausanne) . 2020;11:44. doi:10.3389/fendo.2020.00044 Polit D, Beck C. Essentials of Nursing Research: Appraising Evidence for Nursing Practice. 9th edition. Philadelphia: Lippincott Williams & Wilkins; 2017 Rao N., Tighe E. L., and Feinberg I., “The Dispersion of Health Information–Seeking Behavior and Health Literacy in a State in the Southern United States: Cross‐Sectional Study,” JMIR Formative Research 6, no. 6 (2022): e34708, 10.2196/34708 Ruan X, Zhang N, Wang D, Huang J, Huang J, Huang D, Chun TTS, Ho BSH, Ng ATL, Tsu JHL, Zhan Y, Na R. (2024). The Impact of Prostate-Specific Antigen Screening on Prostate Cancer Incidence and Mortality in China: 13-Year Prospective Population-Based Cohort Study JMIR Public Health Surveill 2024;10:e47161 doi: 10.2196/47161 Song J. H. and Shin S. J., “The Effects of E‐Health Literacy and Subjective Health Status on Health Seeking Behaviors of Elderly Using the Internet in the Community,” Journal of Digital Convergence 18, no. 1 (2020): 321–332, 10.14400/JDC.2020.18.1.321. Soroya S. H., Rehman A. U., and Faiola A., “Exploring the Impact of Internet and Media Sources Exposure on Self‐Care Behavior: Mediating the Role of Health Anxiety, Literacy and Information‐Seeking Behavior,” Kybernetes (2023): 1–21, 10.1108/k-06-2023-1003. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. (2024). Prostate Biopsy. Available from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/prostate-biopsy Tripathy JP, Prasad BM. Cost of diabetic care in India: an inequitable picture. Diabetes Metab Syndr. 2018;12:251–5. Uganda National Council of Science Technology. (2025). National guidelines for research involving humans as research participants. https://www.uncst.go.ug/files/downloads/NATIONAL%20GUIDELINES%20FOR% 20RESEARCH%20INVOLVING%20HUMANS%20AS%20RESEARCH%20PARTICPANTS%202025.pdf Vetterlein MW, Dalela D, Sammon JD, Karabon P, Sood A, Jindal T, et al. State-by-state variation in prostate-specific antigen screening trends following the 2011 United States Preventive Services Task Force Panel update. Urology 2018;112:56–65. Wang X, & Cheng Z (2020). Cross-Sectional Studies: Strengths, Weaknesses, and Recommendations. Chest, 158(1), S65–S71. doi: 10.1016/j.chest.2020.03.012 World Cancer Research Fund. (2024). Prostate cancer statistics. Available from https://www.wcrf.org/preventing-cancer/cancer-statistics/prostate-cancer-statistics/ World Health Organisation. (2024). Global cancer burden growing, amidst mounting need for services. Available from https://www.who.int/news/item/01-02-2024-global-cancer-burden-growing--amidst-mounting-need-for-services World Medical Association World Medical Association. Declaration of Helsinki: Ethical principles for medical research involving human participants. JAMA. 2024 doi: 10.1001/jama.2024.21972. Epub ahead of print. Yadav J, Allarakha S, Menon GR, John D, Nair S. Socioeconomic impact of hospitalization expenditure for treatment of noncommunicable diseases in India: A repeated cross-sectional analysis of National Sample Survey Data, 2004 to 2018. Value Health Reg Issues. 2021;24:199–213 Young, B., Bedford, L., Kendrick, D., Vedhara, K., Robertson, J. F., & Das Nair, R. (2018). Factors influencing the decision to attend screening for cancer in the UK: A meta-ethnography of qualitative research. Journal of Public Health , 40 (2), 315-339. https://doi.org/10.1093/pubmed/fdx026 Zambon A, Nguyen T-A, Fourcade A, Segalen T, Saout K, Deruelle C, et al. Which protocol for prostate biopsies in patients with a positive MRI? Interest in systematic biopsies by sectors. Prostate Cancer Prostatic Dis. 2023. https://pubmed.ncbi.nlm.nih.gov/38114598/. Zeliadt, S. B., M Buist, D. S., Reid, R. J., Grossman, D. C., Ma, J., & Etzioni, R. (2012). Biopsy Follow-Up of Prostate-Specific Antigen Tests. American Journal of Preventive Medicine , 42 (1), 37. https://doi.org/10.1016/j.amepre.2011.08.024 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9220746","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":622536192,"identity":"cec92c0e-690a-4f95-a13a-85a8a4cde12b","order_by":0,"name":"ELTON GEORGE WANDIRA","email":"data:image/png;base64,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","orcid":"","institution":"Global Surgical Initiatives, Inc - 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Kyabirwa Surgical Center","correspondingAuthor":false,"prefix":"","firstName":"ANNA","middleName":"TURUMANYA","lastName":"KALUMUNA","suffix":""},{"id":622536201,"identity":"87518659-c43b-4879-8096-41e92413833b","order_by":9,"name":"MICHAEL MARIN","email":"","orcid":"","institution":"Mount Sinai Hospital","correspondingAuthor":false,"prefix":"","firstName":"MICHAEL","middleName":"","lastName":"MARIN","suffix":""}],"badges":[],"createdAt":"2026-03-25 09:08:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9220746/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9220746/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107426617,"identity":"5bba19f3-0f9f-425d-8225-a0e070caebc6","added_by":"auto","created_at":"2026-04-21 11:27:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":790064,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9220746/v1/d12d495e-d261-43ad-aab6-f3aa8da2d249.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Uptake of Prostate Biopsy and Its Predictors Among Patients Previously Confirmed To Have Elevated Prostate-Specific Antigen Levels At Kyabirwa Surgical Center, Jinja City: A cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA biopsy is a diagnostic procedure that involves removing a small sample of tissue or cells from a specific site in the body for microscopic examination (Johns Hopkins University, 2024). Biopsies are especially crucial for staging potentially metastatic diseases, notably cancers, and for providing confirmatory diagnoses (Mavrogenis et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Some cancers are associated with greater global concern than others, including prostate cancer, the 4th most commonly diagnosed cancer worldwide, with 1.4\u0026nbsp;million new cases annually (Anu et al., 2023; Bray et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; American Cancer Society, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; World Cancer Research Fund, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Prostate cancer affects only men and is the most common cancer among men in 118 countries worldwide (James et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Bray et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Deaths from prostate cancer result from complications that are directly related to cancer stage and complications of late-stage treatment (stage III or IV) (Angulo, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Claa\u0026szlig;en et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Therefore, early diagnosis of prostate cancer is essential for better prognosis and treatment outcomes (James et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), which require initial screening with the prostate-specific antigen (PSA) test. When elevated PSA levels (exceeding 10ng/ml) are detected, prostate biopsy is performed, which involves sampling tissue from the prostate gland with a needle and microscopic examination of cancer cells (Deivasigamani et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Zambon et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Mate et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; The Johns Hopkins University, 2024). Prostate biopsy is considered the gold standard for diagnosing prostate cancer (Devetzis, Kum, Popert, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Novara et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), given its high accuracy and minimal side effects (Mate et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Common complications include hematospermia (Borghesi et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) and acute urinary retention (Borghesi et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), which occur in less than 6% of patients, making it very safe. Its diagnostic accuracy and sensitivity range from 94 to 100% (Dirks et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ariizumi et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Hsiao et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). However, late diagnosis of prostate cancer remains common worldwide (James et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), even among men with a history of elevated PSA levels. Although data on the uptake of biopsies among men with elevated PSA levels are limited, the available evidence by Aly et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) indicates a range of 21.7%\u0026ndash;47.7%. At the Kyabirwa Surgical Center (KSC), cases of men with elevated PSA levels who do not undergo prostate biopsies have been noted, but not quantified. Although approximately 40% of prostate cancer screening tests at the KSC revealed elevated PSA levels, it was hypothesized that some of these patients did not undergo biopsy. The exact proportion remains unknown; only the total number of patients who underwent biopsy at KSC is known, and not the total number of men with elevated PSA levels who were eligible for biopsy. This gap not only exists at KSC but also worldwide; numerous studies have assessed prostate cancer screening rates based on PSA test uptake (Mirzaei-Alavijeh et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Okyere et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ngowi et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Vetterlein et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Leong et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lewis-Thames et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), including Uganda (Mwebembezi et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ekwan et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Nevertheless, very few studies have assessed the uptake of biopsies among men with elevated PSA (\u0026gt;\u0026thinsp;10ng/ml), with only a few studies by Zeliadt et al. (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) and Aly et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) conducted in Sweden. This is a palpable research gap that should be addressed to prevent late-stage diagnosis of prostate cancer and increase five-year survival rates among patients who receive related treatment.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area and design\u003c/h2\u003e \u003cp\u003eThis study was conducted at the Kyabirwa Surgical Center (KSC), the only standalone ambulatory surgical center in Uganda, located in Jinja City, specifically in Kyabirwa Village, Budondo Sub-County. The facility commenced operations in 2019, implying that it has been providing ambulatory surgical care for approximately six years (as of the end of 2025), with the range of care including laparoscopic and laparotomy ambulatory surgeries and minor surgeries such as excisions. In addition to major and minor surgical care, KSC provides a wide range of diagnostic services, including ultrasound scans, colonoscopies, endoscopies, biopsies, and prostate-specific antigen tests (PSA). However, during the time that the center provided PSA tests to men, a trend of some men not subsequently undergoing prostate biopsies, despite having elevated PSA levels detected at the center, has been noted. Even so, some of them might have undergone biopsies at other facilities, but the proportion was unknown and thus, the possible predictors of their prostate biopsy uptake.\u003c/p\u003e \u003cp\u003eTo conduct the study, an analytical cross-sectional design was most suitable, based on the fact that the study involved the assessment of the level of uptake of prostate biopsy among all men who had previously detected elevated PSA levels. Such quantification requires a study population to be categorized into numerator and denominator populations, which is only possible with a cross-sectional design (Alexander et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003ea; Cummings, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Mann, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Wang and Cheng, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Second, the study involved the collection of all data (both exposure and outcome) at the same time for each respondent and did not follow them up, which is also possible with a cross-sectional design. Third, two of the study objectives required an analysis of the associations between exposure and the outcome variable, which was also possible with an analytical cross-sectional design (Alexander et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003ea; Cummings, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Mann, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Wang and Cheng, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population and size\u003c/h3\u003e\n\u003cp\u003eThe study targeted men who underwent a prostate-specific antigen test at the Kyabirwa Surgical Center between 2022 and 2025, given that the center has been providing a diagnostic test since 2022 and that it is within that period that cases of non-uptake of prostate biopsies have been rapidly noted. However, among these men, the study population of interest was those who had a PSA that was equal to or greater than 10ng/ml, detected at Kyabirwa Surgical Center. These men were categorized as having an elevated PSA level and hence had to undergo a prostate biopsy thereafter to allow for the possible early detection of prostate cancer and its prompt and more effective treatment. The study will include men who are available for a 40-minute-long interview and can sustain one such interview without any health-related complaints.\u003c/p\u003e \u003cp\u003eThe study included only men who were seen by clinicians at KSC following the detection of an elevated PSA level, given that it is such patients who had possibly been influenced by institutional characteristics at KSC, and hence, in a position to give responses related to institutional characteristics. The study excluded men previously found to have elevated PSA levels, but who had contraindications for prostate biopsy, including perianal disorders, surgical absence of the rectum, significant immunosuppression, or an infectious disease.\u003c/p\u003e \u003cp\u003eThe sample size of men required for this study was initially calculated using the formula by Daniel (1999), since 242 men with elevated PSA levels had been identified at KSC, between 2022 and 2025, with a population size of less than 10,000. The formula is given by n\u0026thinsp;=\u0026thinsp;X.N / X\u0026thinsp;+\u0026thinsp;N, which is true when X is 384, as provided by the Kish\u0026ndash;Leslie formula (1995), where N is the population size. Using this formula, the initial sample size, with a population size of 242, was 148. However, upon commencement of the sampling process (described in the next section), it was found that most of the men screened for potential inclusion succumbed to prostate cancer were not reachable via telephone or were too morbid to be included in an interview. This left only 52 men who could be practically studied; given such an accessible sample, they were all included.\u003c/p\u003e\n\u003ch3\u003eSampling procedures\u003c/h3\u003e\n\u003cp\u003eThe Kyabirwa Surgical Center maintains a database of all patients who receive surgical and/or diagnostic care services such as the prostate-specific antigen test. Therefore, in liaison with the responsible staff at the KSC, the principal investigator requested a list of all men who underwent PSA testing at the KSC between 2022 and 2024. This list was filtered out along with the PSA result of each man so that at the subsequent stage of sampling, consecutive sampling was used to further screen men with elevated PSA levels. They constituted the final sampling frame, in which consecutive sampling was used to sample all 52 men who met the inclusion criteria of the study and were available for interviews. Consecutive sampling is a non-random sampling technique that was considered the most suitable sampling technique for this study because it is suitable for small population sizes. Consecutive sampling is the least biased of all non-random sampling methods, as it includes all eligible respondents (Polit and Beck, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Therefore, with consecutive sampling, it was possible to include all 52 men, thus maximizing the available population size for men with elevated PSA levels. Each of them was called, assessed for eligibility, briefed about the study, and then looked for and located in their respective communities of residence by the data collection team where they were interviewed.\u003c/p\u003e\n\u003ch3\u003eData collection techniques\u003c/h3\u003e\n\u003cp\u003eStructured interviews were used to collect all self-reported data required for this study, that is, all data that could be validated by the patients. Structured interviews solicit closed-ended responses, which can be quantified during analysis; therefore, since the study took an analytical cross-sectional approach, these interviews sufficed. However, this study also involved document reviews as a second data collection method. Document review was used to verify claims of previous uptake of a prostate biopsy, given that each patient who underwent biopsy was ideally given a medical report to that effect. Thus, each patient who reported having undergone biopsy was requested to provide documentary proof. The medical documents were verified for authenticity by examining the details of the service-providing institution, including their names, serial numbers, and dates. If one reported not having their records or having lost them, the interviewers engaged in extensive probing to verify the claim of having had a biopsy performed. All responses were captured using a structured questionnaire that was uploaded to the Kobo Collect Toolbox. The questionnaire was designed with parts I to IV arranged chronologically, with the study objectives starting with socio-demographic characteristics.\u003c/p\u003e\n\u003ch3\u003eData management and analysis\u003c/h3\u003e\n\u003cp\u003eData captured using the Kobo Collect toolbox were first downloaded into an Excel spreadsheet and then exported to SPSS version 26. Once exported, data cleaning was performed to ensure that all the captured data were cleaned, well-coded, and appropriately entered. Any rectifications were made at this point, and then sample frequency distributions were run to determine whether all data per variable entered were well captured/coded and distributed. This was followed by an analysis of the frequency distributions of each variable, especially the level of uptake of prostate cancer biopsy, as its outcome was a valid percentage. Cross-tabulation distributions were then analyzed between each of the exposure variables and the outcome (uptake of prostate cancer biopsy), after which those with no null integers were subjected to bivariable analysis. Bivariate analysis was performed using a generalized linear model, the appropriateness of which was determined based on the magnitude of the outcome (Martinez et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Nijem et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Barros and Hirakata, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Based on the findings of this study, the magnitude of the outcome was common (\u0026gt;\u0026thinsp;10%); therefore, a log-binomial model was used first at the bivariate level. At that level, all variables with p-values less than 0.2 were considered eligible for multivariable analysis, during which adjustment for confounders was made in a single model. After adjusting for confounders, all variables that remained significant at the 5% alpha level were considered factors associated with prostate biopsy uptake and were reported in terms of adjusted prevalence ratios (aPR), along with their confidence intervals.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eThis study was submitted to the Hospice Africa Uganda Research Ethics Committee (HAUREC) for institutional review and approval, with subsequent approval provided under the number \u003cb\u003eHAU-2024-146\u003c/b\u003e. Further approval to conduct this study in Uganda was obtained from the Uganda National Council of Science and Technology (\u003cb\u003eSS3886ES)\u003c/b\u003e. This was followed by solicitation and receipt of permission to access patient data at the Kyabirwa Surgical Center and conduct the study. Permission was sought from the administration of the center, and each patient sampled was included in the study only if they provided informed consent to be respondents, following the orientation on what the study was about, during the consent process. Each had their data digitally captured and kept on a secure, passworded platform that was installed on the principal investigator\u0026rsquo;s tablet. This meant that the data were kept confidential. All data were anonymized. The names of the patients were used only during the sampling process and were not included in the study. All interviews were conducted in private with full certainty that no third party would listen to the interview between the interviewer and patient.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eHuman Ethics and Consent to Participate declaration\u003c/h3\u003e\n\u003cp\u003eStudy respondents were informed about the voluntary nature of their participation in this study, that they were free to decline participation at their will, and that they could expect no consequences. All participants provided informed consent for this study.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eClinical trial number\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eAccordance statement\u003c/h3\u003e\n\u003cp\u003e The protocol was approved by Hospice Africa Uganda Research Ethics Committee (HAUREC) in accordance with the guidelines of the Helsinki Declaration 2024, (World Medical Association, 2024) and the current Uganda National Council of Science and Technology (UNCST) guidelines (UNCST, 2025).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic characteristics of the respondents\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of the men who were sampled and interviewed\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70\u0026ndash;90 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26(50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(60.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed / Separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (40.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFormally educated\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45 (86.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (13.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (57.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (28.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-secondary (Institute)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrently employed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (48.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (51.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDistrict of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJinja\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (32.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLuuka\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (7.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMpigi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(5.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBuyende\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKamuli\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9(17.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMayuge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(7.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBugiri\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBuikwe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(7.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTororo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKayunga\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIganga\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(5.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBugweri\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKaliro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEqual proportions of the patients were aged between 50 and 70 years (26, 50.0%) and between 70 and 90 years (26, 50.0%). The majority were cohabiting (9, 60.0%) and formally educated (45, 86.5%), although more than half of those who were formally educated were educated to the primary level (26, 57.8%). More than half of the patients who participated in this study were not currently employed (27, 51.9%), and almost two-thirds were residents of Jinja City (17, 32.7%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBiopsy uptake\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssessment of biopsy uptake characteristics among patients found to have elevated PSA at Kyabirwa Surgical Centre\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUp took prostate biopsy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUp taken\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (55.8)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23 (44.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFacility from which the biopsy was done\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt Kyabirwa Surgical Center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (72.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJinja RRH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (10.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMengo Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (6.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMulago NRH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOld Kampala Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMbale RRH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIf Kyabirwa Surgical Center, the time taken until doing a biopsy, following the reception of PSA results\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 2 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (52.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 to 4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIf not at Kyabirwa surgical center, the time taken until doing a biopsy, following the reception of PSA results\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e*Frequency and percentage showing prostate biopsy uptake\u003c/h2\u003e \u003cp\u003eThe majority of the patients had undergone prostate biopsy (55.8%), and almost three-quarters of them underwent biopsy at the Kyabirwa Surgical Center (21, 72.4%). Among the patients who underwent biopsy at KSC, more than half underwent the test within 2 weeks of being told to have it done (11, 52.4%). However, half of those who had undergone biopsy elsewhere took months to do so, following the reception of an elevated PSA result (4, 50.0%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePredictors of biopsy uptake\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate and multivariate analysis of the predictors among patients previously confirmed to have elevated Prostate-Specific Antigen levels at Kyabirwa Surgical Center, Jinja city\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eProstate biopsy uptake\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eCrude estimates\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eAdjusted estimates\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUp taken\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNot up taken\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ecPR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eaPR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI think I am still healthy; I will have the biopsy done anytime.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(73.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.368 (0.154\u0026ndash;0.878)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.024\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.363 (0.152\u0026ndash;0.866)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.022\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndecided\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.690 (0.333\u0026ndash;1.431)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.673 (0.324\u0026ndash;1.401)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21(72.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(27.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealthcare workers at KSC educated patients about prostate health.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22(75.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (24.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.129 (1.117\u0026ndash;4.060)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.022\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.150 (1.157\u0026ndash;3.995)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(30.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(69.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealthcare workers at KSC educated patients about what the PSA results meant.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (75.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(24.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.493 (1.300\u0026ndash;4.780)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.404 (1.264\u0026ndash;4.572)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(30.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(69.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealthcare workers at KSC educated patients about the importance of a biopsy and how it is done.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21(72.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(27.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.082 (1.139\u0026ndash;3.805)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.017\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.413 (1.348\u0026ndash;4.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(34.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(65.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealthcare workers at KSC told the patient about the cost of a prostate biopsy.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21(72.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(27.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.082 (1.139\u0026ndash;3.805)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.017\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.120 (1.159\u0026ndash;3.878)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(34.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(65.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealthcare workers at KSC followed up on the patient's instruction to do a biopsy.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.582 (0.986 \u0026minus;\u0026thinsp;2.538)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.603 (1.074\u0026ndash;2.394)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (45.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (54.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the predictors of biopsy uptake among patients previously confirmed to have elevated Prostate-Specific Antigen levels at the Kyabirwa Surgical Center in Jinja City. Six predictors were identified, of which one was an intrapersonal predictor and five were institutional predictors. Biopsy uptake was 74% lower among patients who thought that they were still healthy and could undergo biopsy at any time (aPR\u0026thinsp;=\u0026thinsp;0.363, 95% CI\u0026thinsp;=\u0026thinsp;0.152\u0026ndash;0.866, p\u0026thinsp;=\u0026thinsp;0.022) than among those who perceived that they were not healthy. Biopsy uptake was twice as high among patients who were educated about prostate health by healthcare workers at KSC (aPR\u0026thinsp;=\u0026thinsp;2.150, 95% CI\u0026thinsp;=\u0026thinsp;1.157\u0026ndash;3.995, p\u0026thinsp;=\u0026thinsp;0.015) than among those who were not educated about prostate health. It was also twice as high among patients who were educated about the PSA results (aPR\u0026thinsp;=\u0026thinsp;2.404, 95% CI\u0026thinsp;=\u0026thinsp;1.264\u0026ndash;4.572, p\u0026thinsp;=\u0026thinsp;0.007) and those who were educated about the importance of a biopsy and how it was performed (aPR\u0026thinsp;=\u0026thinsp;2.413, 95% CI\u0026thinsp;=\u0026thinsp;1.348\u0026ndash;4.317, p\u0026thinsp;=\u0026thinsp;0.003) than among those who were not educated. A high biopsy uptake prevalence was also observed among patients who were informed about the cost of prostate biopsy (aPR\u0026thinsp;=\u0026thinsp;2.120, 95% CI\u0026thinsp;=\u0026thinsp;1.159\u0026ndash;3.878, p\u0026thinsp;=\u0026thinsp;0.015) and those who were followed up by healthcare workers at KSC to determine compliance with the instructions to perform a biopsy (aPR\u0026thinsp;=\u0026thinsp;1.603, 95% CI\u0026thinsp;=\u0026thinsp;1.074\u0026ndash;2.394, p\u0026thinsp;=\u0026thinsp;0.021).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study established that the level of uptake of prostate biopsy among men eligible for it, following diagnosis of an elevated PSA level at Kyabirwa Surgical Center, is fair; approximately 56% of those men underwent biopsy. This translates to about half of all such men, which leaves half of them as non-takers of the definitive test for prostate cancer and at risk of being later diagnosed with that disease at a late stage (Chen et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Fr\u0026aring;nlund et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). That is, irrespective of the fact that elevated PSA levels do not necessarily increase risk for cancer development due to the low specificity of PSA tests (Leal et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), which puts between 10 and 30% of patients with high PSA values at real risk for developing the disease (David and Leslie, 2025). The proportion of patients who might have developed prostate cancer notwithstanding, the fact remains that some of those who did not undergo biopsy since 2022 most likely developed the disease despite the window for possible detection at an early stage. This assertion could be substantiated by the finding that a significant proportion of patients who had been screened out of the KSC database actually succumbed to prostate cancer. Thus, the suboptimal level of uptake of prostate biopsy was indeed a problem among men referred to have it performed elsewhere or at KSC. Although there have been very few explicit assessments of prostate biopsy uptake levels among men with elevated PSA levels, there is high certainty that the problem is global. As mentioned earlier, there has been significant interest in prostate cancer screening using the PSA test in most previous studies. The level of screening uptake reported in previous studies was low, as reported by Leapman et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) (36.5%) in the United States, Ruan et al. (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) (17.9%), Mirzaei-Alavijeh et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) (16.9%), Bello et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) in Nigeria (7.1%), Ojewola et al. (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) (10.2%), Okyere et al. (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) (4.4%), and Mwebembezi et al. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) (3.3%) in Uganda. The main difference between these previous findings and those revealed by this study is that the respondents in this study were men who had already undergone PSA and interacted with healthcare providers. This made them more likely to have comparatively better health-seeking behaviors, which explained their higher level of biopsy uptake (55.8%). Nonetheless, this was still suboptimal, although men who underwent biopsy had some characteristics that could be capitalized in the future to ensure higher uptake. All these characteristics were institutional in nature and related to patient-provider interaction and/or healthcare worker behavior in general, consistent with the findings of Mwebembezi et al. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), Tripathy et al. (2018), Yadav et al. (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), Tripathy et al. (2018), and Bhoo-Pathy et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe found that patients who received education on prostate health from healthcare workers at the KSC compared to those who did not receive such education. This finding relates to what is called patient activation, which is the increase in knowledge, skills, and confidence a patient has in managing their own health (Mosen et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2007\u003c/span\u003e), simply by educating them about a specific aspect of their health, such as prostate health. Prostate health education includes explaining the functions of the prostate gland, maintaining prostate health, signs of deterioration, and common complications, such as enlargement and cancer, and how to prevent these through screening. Providing this information to patients with elevated PSA levels is sufficient to improve their health literacy (Jones et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Rao et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Song and Shin, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Soroya et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Graffegna et al., 2017), increase their activation, and make them more likely to change their behavior. In this study, such behavioral changes refer to proceeding with prostate biopsy, and this remains true when patients are educated about what PSA results mean. This explains why the rate of biopsy uptake was still twice as high among patients who understood PSA results. These patients learn what an elevated PSA level signifies and the importance of a confirmatory diagnostic test for potential prostate cancer.\u003c/p\u003e \u003cp\u003eWe also found that the prevalence of prostate biopsy uptake was twice as high among patients who were educated about the importance of a biopsy and how it was performed compared with those who were not educated about it. Such education has the same effect of increasing patient activation; in addition, it comes with a complementary effect of allaying fears that are usually associated with having a biopsy performed. A biopsy is one of the most renowned antagonists of its uptake (Mndzebele \u0026amp; Mogale, 2015; Young et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Opondo et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Abuadas et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Hejase et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Ngowi et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Muliira et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Annan et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). It can be significantly allayed through demystification of any concerns and misconceptions that a patient may have, and an explanation of the procedure is given with emphasis on its generally low pain experience, leading to an uninhibited choice to undergo the biopsy. The fear of a biopsy can include fear of the pain associated with that biopsy and the high cost of the procedure, especially to the rural poor to which KSC typically provides care. Thus, if the education a patient receives also covers issues related to how much it would cost them to have it done, especially at the KSC, where the costs are subsidized, the potential cost barrier to uptake would be significantly minimized, paving the way for uptake. This explains why a higher biopsy uptake prevalence was also registered among patients who were informed about the cost of prostate biopsy. However, education about biopsy, its cost, and procedures may not be an end in itself; its effectiveness can be augmented when supplemented with follow-up calls made by healthcare workers. Patient follow-up ensures that the attitudinal and behavioral change patterns of a patient following education are monitored for further reinforcement, if necessary, especially if no biopsy uptake has occurred. Thus, patient follow-up can reinforce patient activation and guarantee uptake of a biopsy, which explains the finding that patients who were followed up by healthcare workers at the KSC to determine compliance with the instructions to perform a biopsy had a 60% higher prevalence of biopsy uptake than those who were not followed up.\u003c/p\u003e \u003cp\u003eWhile five of the six significant predictors of prostate biopsy uptake increased uptake, the sixth predictor identified reduced uptake and was the perception of being healthy. The findings indicated that the uptake of biopsy was 74% lower among patients who thought that they were still healthy and could undergo biopsy at any time compared to those who perceived that they were not healthy. This finding relates to low perceived risk of developing prostate cancer, which has been previously reported to bar screening service uptake in previous studies as well (Opondo et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Abuadas et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). This is because, if one has an elevated PSA test result but still thinks they are physically healthy, they find no reason to go ahead and have a confirmatory diagnosis of possible prostate cancer.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eWhile the study included all men who met the eligibility criteria, most of those with elevated PSA volumes between 2022 and 2025 were not accessible, which might have led to a type 1 error. Second, while we had a criterion that excluded men who had contraindications for prostate biopsy screening, it was not possible to definitively verify most of these contraindications during the community survey. Self-reports were relied upon in those few cases, implying that there could have been some underestimation of biopsy uptake caused by the exclusion of men who could have been eligible for the study. In this case, probing was used as a countermeasure to minimize erroneous exclusions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe uptake of prostate biopsy among patients previously found to have elevated Prostate-Specific Antigen levels at the Kyabirwa Surgical Center is fair; only half of them go ahead to undergo biopsy. Therefore, half of all men found to be eligible for prostate cancer biopsy at the center do not have that biopsy performed, at least not at the KSC. Only a few of them have done so at other facilities, further emphasizing the fact that prostate cancer screening behavior is poor among men who are urged to undergo screening via biopsy by the KSC staff. Prostate cancer-related mortality among men potentially diagnosed with the disease at KSC will continue to be a challenge despite the status quo being maintained, even though KSC has the capacity to provide preventive health promotion services. To augment prostate cancer biopsy uptake among men, KSC administration must strengthen its patient-provider interaction quality, especially for men with elevated PSA levels. A facility policy should be made for all men found to have such test outcomes to receive sufficient education on issues related to prostate health, what a biopsy is, how it is done, and its cost, as such educational points have been found to increase patient activation. This should be in addition to incorporating risk education into such interactions, tailored to increase prostate cancer risk perceptions among all men who are eligible for biopsy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during this study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that this study was not funded.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbuadas MH, Petro-Nustas W, Albikawi ZF. 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Comparison of diagnostic accuracy of thyroid cancer with ultrasound-guided fine-needle aspiration and core-needle biopsy: a systematic review and meta-analysis.  \u003cem\u003e\u0026nbsp;Front Endocrinol (Lausanne)\u003c/em\u003e. 2020;11:44. doi:10.3389/fendo.2020.00044\u003c/li\u003e\n \u003cli\u003ePolit D, Beck C. Essentials of Nursing Research: Appraising Evidence for Nursing Practice. 9th edition. Philadelphia: Lippincott Williams \u0026amp; Wilkins; 2017\u003c/li\u003e\n \u003cli\u003eRao N., Tighe E. L., and Feinberg I., \u0026ldquo;The Dispersion of Health Information\u0026ndash;Seeking Behavior and Health Literacy in a State in the Southern United States: Cross‐Sectional Study,\u0026rdquo; JMIR Formative Research 6, no. 6 (2022): e34708, 10.2196/34708\u003c/li\u003e\n \u003cli\u003eRuan X, Zhang N, Wang D, Huang J, Huang J, Huang D, Chun TTS, Ho BSH, Ng ATL, Tsu JHL, Zhan Y, Na R. (2024). The Impact of Prostate-Specific Antigen Screening on Prostate Cancer Incidence and Mortality in China: 13-Year Prospective Population-Based Cohort Study\u003cbr\u003eJMIR Public Health Surveill 2024;10:e47161\u003cbr\u003edoi: 10.2196/47161\u003c/li\u003e\n \u003cli\u003eSong J. H. and Shin S. J., \u0026ldquo;The Effects of E‐Health Literacy and Subjective Health Status on Health Seeking Behaviors of Elderly Using the Internet in the Community,\u0026rdquo; Journal of Digital Convergence 18, no. 1 (2020): 321\u0026ndash;332, 10.14400/JDC.2020.18.1.321.\u003c/li\u003e\n \u003cli\u003eSoroya S. H., Rehman A. U., and Faiola A., \u0026ldquo;Exploring the Impact of Internet and Media Sources Exposure on Self‐Care Behavior: Mediating the Role of Health Anxiety, Literacy and Information‐Seeking Behavior,\u0026rdquo; Kybernetes (2023): 1\u0026ndash;21, 10.1108/k-06-2023-1003.\u003c/li\u003e\n \u003cli\u003eThe Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. (2024). Prostate Biopsy. Available from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/prostate-biopsy\u003c/li\u003e\n \u003cli\u003eTripathy JP, Prasad BM. Cost of diabetic care in India: an inequitable picture. Diabetes Metab Syndr. 2018;12:251\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003eUganda National Council of Science Technology. (2025). 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Factors influencing the decision to attend screening for cancer in the UK: A meta-ethnography of qualitative research. \u003cem\u003eJournal of Public Health\u003c/em\u003e, \u003cem\u003e40\u003c/em\u003e(2), 315-339. https://doi.org/10.1093/pubmed/fdx026\u003c/li\u003e\n \u003cli\u003eZambon A, Nguyen T-A, Fourcade A, Segalen T, Saout K, Deruelle C, et al. Which protocol for prostate biopsies in patients with a positive MRI? Interest in systematic biopsies by sectors. Prostate Cancer Prostatic Dis. 2023. https://pubmed.ncbi.nlm.nih.gov/38114598/.\u003c/li\u003e\n \u003cli\u003eZeliadt, S. B., M Buist, D. S., Reid, R. J., Grossman, D. C., Ma, J., \u0026amp; Etzioni, R. (2012). Biopsy Follow-Up of Prostate-Specific Antigen Tests. \u003cem\u003eAmerican Journal of Preventive Medicine\u003c/em\u003e, \u003cem\u003e42\u003c/em\u003e(1), 37. https://doi.org/10.1016/j.amepre.2011.08.024\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9220746/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9220746/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eTo assess prostate biopsy uptake and its predictors among patients previously found to have elevated Prostate-Specific Antigen results at the Kyabirwa Surgical Center.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eAn analytical cross-sectional design was employed to study male patients with elevated PSA levels (\u0026gt; 10 ng/mL) at the Kyabirwa Surgical Center. They were consecutively sampled, located in their areas of residence, and engaged in structured interviews. Data were collected and analyzed descriptively using SPSS version 26, with a log-binomial model for relationship analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe proportion of patients with elevated PSA levels at the Kyabirwa Surgical Center (KSC) who underwent prostate biopsy was 55.8%, the majority of whom underwent biopsy at the center (72.4%). Perceived good health and the ability to perform biopsy at any time lowered the prevalence of uptake.However, educating patients about prostate health, the cost of a prostate biopsy, the mean PSA results, the importance of a biopsy, how it is performed by healthcare providers at KSC, and being followed up by healthcare workers at KSC to determine compliance with the instructions to perform a biopsy increases biopsy uptake.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe uptake of prostate biopsy among patients previously found to have elevated Prostate-Specific Antigen levels at the Kyabirwa Surgical Center is fair; only half of them go ahead to undergo biopsy. Antagonists of prostate biopsy uptake are patient-related, while all protagonists are institutional and specifically related to post-test patient education.\u003c/p\u003e","manuscriptTitle":"Uptake of Prostate Biopsy and Its Predictors Among Patients Previously Confirmed To Have Elevated Prostate-Specific Antigen Levels At Kyabirwa Surgical Center, Jinja City: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-21 11:26:08","doi":"10.21203/rs.3.rs-9220746/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-13T17:46:57+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"330492247609654429714908266075710295075","date":"2026-05-11T11:20:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-10T09:51:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T22:22:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"300690839648533752487911638033114420794","date":"2026-05-06T12:31:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"327764467380111412919860647365931273468","date":"2026-05-06T02:21:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-13T19:45:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-01T21:19:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-28T07:28:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-28T07:28:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2026-03-25T08:57:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a40151d5-aeeb-42c1-b05d-698cc7730269","owner":[],"postedDate":"April 21st, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-13T17:46:57+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"330492247609654429714908266075710295075","date":"2026-05-11T11:20:15+00:00","index":80,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-10T09:51:54+00:00","index":78,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T22:22:13+00:00","index":77,"fulltext":""},{"type":"reviewerAgreed","content":"300690839648533752487911638033114420794","date":"2026-05-06T12:31:33+00:00","index":74,"fulltext":""},{"type":"reviewerAgreed","content":"327764467380111412919860647365931273468","date":"2026-05-06T02:21:33+00:00","index":72,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T17:53:47+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-21 11:26:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9220746","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9220746","identity":"rs-9220746","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}