The profile of Black South African men diagnosed with prostate cancer in the Free State, South Africa

Abstract

Background: Prostate cancer (PCa) ranks high in terms of morbidity and mortality, especially in Africa. Prostate-specific antigen (PSA) screening remains a practical method of screening for and thereby detecting PCa early, especially among African men who are more negatively affected. Modifiable risk factors for PCa are mostly behavioural and lifestyle. Understanding community-specific determinants is important when developing health promotion interventions.Objective: This study aimed to determine the profile of African men with PCa in the Free State, South Africa.Method: A cross-sectional descriptive study was conducted using case record information and self-administered questionnaires among 341 African men with PCa attending the oncology and urology clinics of a tertiary hospital.Result: Participants’ median age at diagnosis was 66 years. Only 76 (22.3%) participants had ever heard of PCa prior to being diagnosed with the disease, 36 (47.4%) of whom had ever had screening performed. The majority (n = 298, 87.4%) were symptomatic; 50% sought medical help within six months. At diagnosis, 133 (39.0%) men presented with stage T3 or T4 disease, 75 (22.0%) with metastatic disease and 84 (24.6%) with Gleason score ≥ 8. Factors associated with advanced and high-grade disease included smoking, decreased sunlight exposure and physical activity, relatively increased ingestion of dairy products and red meat. Factors associated with early stage and low-grade disease included relatively increased ingestion of fruits, vegetables and fish.Conclusion: Advanced and high-grade PCa disease is not uncommon among men ≥ 60 years in this study setting. Certain modifiable risk factors associated with advanced disease were established in this study. The majority had lower urinary tract symptoms (LUTS) prior to PCa diagnosis, but they were of poor health-seeking behaviour. Although there seems not to be a systematic delay in the definitive diagnosis and initiation of treatment for PCa, there is a need to improve on health education and awareness in the study setting.

Linking African ancestral substructure to prostate cancer health disparities

“…Other than the genetic factors, an explanation for this association is that reportedly, only 9.9% of Black South Africans have private health insurance and are therefore reliant on often over-crowded and under-resourced public healthcare services; while 72.9% of Europeans, 52% of Indians and 17.1% of South African Coloured report having private health insurance 22 . Additionally, a recent study in South Africa of 341 PCa cases reported that only 76 (22.3%) had awareness of PCa before diagnosis, with less than 50% of cases seeking medical help after PCa diagnosis 23 , and as such we call for further programs focused on bringing education and awareness across the region.…”

Linking African ancestral substructure to prostate cancer health disparities

“…Other than the genetic factors, an explanation for this association is that reportedly, only 9.9% of Black South Africans have private health insurance, and are therefore reliant on often over-crowded and under-resourced public healthcare services; while 72.9% of Europeans, 52% of Indians and 17.1% of South African Coloured report having private health insurance 28 . Additionally, a recent study in South Africa of 341 PCa cases reported that only 76 (22.3%) had awareness of PCa before diagnosis and less than 50% of the cases sought medical help after being diagnosed 29 , and as such we call for further programs focused on bringing education and awareness across the region.…”

The South African Prostate Cancer Screening Guidelines

“…The authors have had to strike a balance and make recommendations applicable to both a well-resourced private sector and an under-resourced public sector. Epidemiological data showing the burden of disease, especially the rates of advanced disease in the coloured and black SA populations, [3,4,[37][38][39][40] suggest that a national PCa screening programme will be worthwhile; however, multiple factors make the roll-out of such a campaign particularly complex. 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.…”