Prostate cancer is one of the most common cancers affecting men worldwide. According to the World Health Organisation (WHO), in 2020 prostate cancer accounted for 14.1% of all cancers diagnosed in men. There were 1,414,259 reported new cases worldwide and 375 304 deaths in that year alone1. While these statistics and the rising global incidence are startling, so too is the fact that the prevalence and severity of prostate cancer are notably higher among black men2.
Globally the risk of prostate cancer for black men should be cause for concern
As many as 1 in 6 black men will be diagnosed with prostate cancer in their lifetime compared to 1 in 8 white men3.
Available global data also indicates that black men have a 70% greater chance of being diagnosed with prostate cancer than white men and are twice as likely as white men to die from prostate cancer2.
More concerning is that in a country like South Africa, while prostate cancer is the most commonly diagnosed cancer among men of all races, black African men generally present later with a more advanced stage and higher histological grade than their non-black counterparts.
Studies in South Africa reveal startling insights
A recent study done by the University of Free State showed that only 22% of the study participants had ever heard of prostate cancer before being diagnosed with the disease.
“We need to go above and beyond to make sure every South African man over 40 fully understands the importance and process of prostate cancer screening,” says Andrew Oberholzer, CEO of the Prostate Cancer Foundation of South Africa. “Most South African men with prostate cancer already have advanced or locally advanced prostate cancer.”
“At this stage, the cancer is no longer curable,” he says, adding that there is a dire need to raise awareness about the disease.”
“All the data shows very clearly that if you pick up prostate cancer early, which requires screening, you have a 95% chance of being cured and will have a similar life expectancy to someone without the cancer”, says Professor Shingai Mutambirwa, Head of Department of Urology at Sefako Makgatho Health Sciences University (SMU) in Pretoria and a founding member of the Prostate Cancer Foundation of South Africa (PCF).
Prostate cancer survival rates are not as high when the cancer has metastasized, or spread beyond the prostate4. “A PSA blood test at your health care practitioner can take a couple of seconds and can potentially save your life,” he says.
A significant public health concern
Dr Matthew Benedict, is a Senior Lecturer and Medical Specialist in the Department of Family Medicine in the Faculty of Health Sciences at the University of the Free State (UFS). He agrees “Prostate cancer and the mortality rates associated with it, particularly among black men, are on the rise in South Africa, regardless of the existing national guidelines for prostate-specific antigen (PSA) screening. These increases represent a significant public health concern. ”
Dr Benedict graduated with a Doctor of Philosophy degree at the December 2023 graduation ceremonies. Alongside his colleague, Dr Chika Egenasi, they became the first PhD holders with a specialisation in Clinical Family Medicine at the UFS.
Their study could help elevate awareness around prostate cancer and ultimately enhance screening practices aimed at black men.
Dr Benedict says prostate cancer cases increased from 29 per 100 000 men in 2007 to 68 per 100 000 men in 2018. PSA screening remains a practical method for early detection and improved outcomes, despite the risks of overdiagnosis and overtreatment. The existing approach to prostate cancer screening, however, fails to adequately address the unique challenges faced by black men.
What’s Driving The High Incidence of Prostate Cancer Among Black Men?
Underrepresentation of men’s health issues
Dr Benedict ‘s study identified gaps relating to the prostate cancer screening approach in the Free State by simultaneously exploring two perspectives – that of primary healthcare providers and black men (healthcare users) – and the proffered strategies to address the identified gaps.
The decision to embark on this research stemmed from the observed underrepresentation of men’s health issues in South African healthcare systems and media. Dr Benedict highlighted that despite the existence of national registries for breast and cervical cancers, there is a notable absence of a similar registry for prostate cancer (PCa).
“This lack of prioritisation and emphasis on secondary prevention strategies tailored to PCa is evident. Additionally, the racial disparities in PCa morbidity and mortality are exacerbated by inadequate representation of black men in research on this disease,” he says.
Low screening uptake
In the Free State, which has the lowest life expectancy compared to the national average, the black population faces disproportionate challenges related to lower socioeconomic status and poorer health outcomes. Prioritising equitable access to essential primary healthcare services, including screening, is crucial in this context.
Dr Benedict explained that the findings of his research revealed that aggressive prostate cancer is prevalent among black men in the study setting, with poor knowledge and awareness of the disease and low screening uptake being observed. “Factors such as dietary habits, lifestyle, and presentation time were associated with aggressive disease at diagnosis, and cultural beliefs influenced screening uptake among men.
“Factors associated with a higher intention to screen included reduced fear, perceived benefits, situational barriers, and perceived risk of developing prostate cancer. The majority of the primary healthcare providers demonstrated poor knowledge (64.8%), neutral attitudes (58.6%) and poor practice (40.0%) related to prostate cancer screening. Female providers, lower cadre nurses and community health workers had lower knowledge scores.”
The study also found lack of prostate cancer-related continuing education was significantly associated with poor knowledge, negative attitudes, and poor practice among healthcare providers.
The study proposed strategies to address the identified gaps among black men and primary healthcare providers. Community-oriented approaches involving the active participation of both healthcare providers and community members were emphasised. These strategies focused on the discussion of prostate cancer health education topics in public spaces, employing diverse, comprehensive, user-friendly, and culturally sensitive methods.
Delay in diagnosing
According to Dr Benedict, the delay in diagnosing prostate cancer among South African individuals is linked to the absence of a dedicated screening programme, and a predominantly rural population facing challenges like low socioeconomic status, high unemployment rates, and limited health literacy. Cultural perceptions of the disease, men’s perspectives on masculinity and illness, a hesitancy to seek help, and a reluctance to assume the sick role also contribute.
Traditional beliefs
“Furthermore, adherence to strong traditional beliefs often steers individuals towards consulting traditional healers instead of seeking medical assistance in clinics or hospitals. Numerous barriers to accessing health services in impoverished rural communities compound the issue, leading to instances of ‘lost to follow-up’ [patients who drop out of research studies or treatment programmes].”
Symptoms of prostate cancer
Prostate cancer might not exhibit noticeable symptoms during its initial stages, explained Dr Benedict, but as the condition progresses patients may experience diverse symptoms.
- The majority of these patients commonly experience signs of bladder outflow obstruction, such as a weakened urine stream, hesitancy in urination, nocturia, and a sense of incomplete bladder emptying.
- In certain instances, the tumour can lead to acute urinary retention.
- Advanced prostate cancer may present with symptoms linked to ureteric obstruction or bony metastasis. Night-time pain that alleviates with movement can result from bone metastasis.
According to the researcher, the primary focus of the research is on screening and early diagnosis. Screening involves assessing apparently healthy individuals for the presence of a disease, even if symptoms are not evident. While specific symptoms like lower urinary tract symptoms may indicate conditions such as benign prostatic hyperplasia or urinary tract infections rather than prostate cancer, the presence of more advanced symptoms like lower back pains, weight loss, and bloody urine often suggest a more progressed stage of the disease.
Enhanced screening practices
Getting tested
A PSA or Prostate-Specific Antigen blood test is used to screen for prostate cancer. The prostate gland makes a protein called protein-specific antigen (PSA), with high PSA levels indicating the possible presence of cancer4.
According to the Prostate Cancer Foundation of South Africa, all men over the age of 45 need to be screened annually, with higher risk groups including black men and men who have a family history of prostate and/or breast cancer in a first-degree relative needing to get screened annually from the age of 40.
Raising Awareness
Longevity is the right all and education and information is key and anyone can play a part in raising awareness.
Andrew Oberholzer, CEO of the Prostate Cancer Foundation of South Africa says companies play an important role in raising awareness. For example, “ Events like the Hollard Daredevil Run are critical as they generate much needed educational opportunities on a national level for men and boys to talk about prostate and testicular cancers.”
The Daredevil Run, is a unique event where brave men don their purple Speedos and take to the streets to raise awareness of testicular and prostate cancer. This is a partnership between Hollard Insurance, the CANSA (Cancer Association of South Africa) and the PCF (Prostate Cancer Foundation).
Main photo credit: Courtesy of Hollard Insurance Events.
References
1 https://www.medicalbrief.co.za/unequal-burden-of-prostate-cancer-for-africa/
2 https://www.mskcc.org/news/things-black-men-should-know-about-prostate
3 https://prostate-ca.co.za/information-on-the-diagnosis-treatment-of-prostate-cancer/
4 https://my.clevelandclinic.org/health/diseases/8634-prostate-cancer
