Prostate Cancer Disparities and Management in Southern Africa: Insights into Practices, Norms and Values

Abstract

Prostate cancer (PCa) is a leading cause of mortality in men of African origin. While men of African descent in highincome countries (HICs) demonstrate poor prognosis compared to their European counterparts, African men on the African continent, particularly Southern Africa have shown even higher PCa mortality rates. Extrinsic factors such as the socioeconomic status, education level, income level, geographic location and race contribute to PCa patient outcome. These are further deepened by the African norms which are highly esteemed and may have detrimental effects on PCa patients' health. Insights into African cultures and social constructs have been identified as key elements towards improving men's health care seeking behaviour which will in turn improve PCa patients' outcome. Compared to Southern Africa, the Eastern, Western and Central African regions have lower PCa incidence rates but higher mortality rates. The availability of cancer medical equipment has also been reported to be disproportionate in Africa, with most cancer resources in Northern and Southern Africa. Even within Southern Africa, cancer management resources are unevenly available where one country must access PCa specialised care in the neighbouring countries. While PCa seems to be better managed in HICs, steps towards effective PCa management are urgently needed in Africa, as this continent represents a significant portion of lowmiddle-income countries (LMICs). Replacing African men in Africa with African American men may not optimally resolve PCa challenges in Africa. Adopting western PCa management practices can be optimised by integrating improved core-African norms. The aim of this review is to discuss PCa disparities in Africa, deliberate on the significance of integrating African norms around masculinity and discuss challenges and opportunities towards effective PCa care in Africa, particularly in Southern Africa.

The South African Prostate Cancer Screening Guidelines

“…Various studies have reported on the barriers to PCa screening in Africa, which include lack of patient education, poor uptake in low socioeconomic communities, and lack of resources to implement screening as well as treatment. [2,41] The logistical and resource-related challenges to roll out an effective screening programme would be immense but not insurmountable. Achieving good uptake and participation in such a programme, especially in the black South African male population, will require an in-depth understanding of cultural and gender-specific beliefs within the different communities, especially in rural areas, where these ideas are even more entrenched.…”

“…Achieving good uptake and participation in such a programme, especially in the black South African male population, will require an in-depth understanding of cultural and gender-specific beliefs within the different communities, especially in rural areas, where these ideas are even more entrenched. [2,39] The dearth of urological services to treat increased numbers of PCa patients, especially in the public sector, [42,43] leaves us with ethical questions regarding the initiation of a more robust screening programme. The inevitable increased burden of disease may, on the other hand, place greater focus on the severely under-resourced men's health sector in our country.…”

“…[1] In South Africa (SA), PCa is the predominant solid organ cancer detected, regardless of ethnic background, [1] and its prevalence in southern Africa has increased by ~60% during the past 15 years. [2] Black SA men typically receive a diagnosis at a more advanced stage and exhibit a higher histological grade compared with SA men of other ethnic backgrounds. [3,4] Organised screening of asymptomatic men uses prostate-specific antigen (PSA) testing to detect cancer in its early stages and reduce PCa-related morbidity and mortality.…”

Knowledge and attitude of physicians towards prostate cancer screening in Baghdad

“…By focusing on improving diagnostic capabilities, implementing effective screening strategies, and fostering education about the disease, these regions can make significant strides in the battle against prostate cancer. Collaborative efforts are essential to ensure that men across these diverse landscapes have access to the information and healthcare services necessary for the early detection and management of prostate cancer, ultimately improving survival rates and quality of life for those affected by this disease [14] . The aim of study is to evaluate the understanding and stance of physicians in Baghdad regarding prostate cancer screening.…”

Prostate cancer perspective: Africa versus the world

“…[1] Black African men have been found to present later with a more advanced stage and higher histological grade at presentation than their non-black counterparts. [2] The incidence of PCa in southern Africa has increased by an estimated 60% in the past decade and a half [3] and could lead to an increase in mortality rates in black African men if the disease is not adequately and timeously managed.Another concern is the disparity in resources for diagnosing and treating PCa at any stage in developing countries, especially African countries, when compared with the developed world. Although Northern and Western Europe have some of the highest PCa incidence rates globally, at the same time they also have very low mortality rates.…”