26 Introduction Globally, cancer is a major health burden and is on an upward trend. Estimates from the Global Cancer Observatory of the International Agency for Research on Cancer showed an incidence and mortality of 18.1 million and 9.6 million, respectively, in 2018. These gures increased to 19.3 million and about 10 million, 1,2 respectively, in 2020. Prostate cancer (PCa) ranks the second most frequent cancer diagnosis and the fth leading cause of death among men worldwide. Its global incidence and mortality for 2018 were 1.3 million and 360 000, respectively. These gures increased to 1.4 1,2 million and 375 000, respectively, in 2020. The impact is greater in Africa and low-and middle-income countries (LMICs) because of genetic, socio-economic and 3,4 sociocultural factors. In South Africa, PCa is the most 5 common cancer among men, and there has been an increase in PCa incidence rate from 29 per 100 000 men 6 7 in 2007 to 68 per 100 000 men in 2018. Prostate cancer accounts for about 13% of male deaths from cancer in 8 South Africa. Prostate cancer in Black South African men is more likely to be hereditary than in other racial groups; 9 hence, they are disproportionately affected. The South African government, through the National Development Plan 2030, sets out nine long-term health goals, one of which is to 'signicantly reduce prevalence of non10 communicable diseases'. Prostate-specic antigen (PSA) screening for PCa, although controversial because of the associated falsepositive results, overdiagnosis, overtreatment and the 11 related complications, remains a practical method of early detection, early treatment and prevention of 12 metastatic disease and complication, especially in Africa where there is higher mortality compared with 13 other regions of the world. According to the United States (US) Preventive Task Force, there is a likelihood for a decreased mortality from PCa in men aged 55–69 years with PSA screening; there is currently no benet shown in screening men above 70 11,14 years of age. In contrast, the South African PCa 15 diagnostic and treatment guidelines (SAPCDTGs) recommend PSA testing for men with a life expectancy of more than 10 years and with any of the following criteria: (1) Black Africans ≥ 40 years and those with family history of prostate or breast cancer in a rst-degree relative, (2) men of other races ≥ 45 years and (3) men with history of lower urinary tract symptoms (LUTS) and clinical suspicion of PCa, regardless of age group. According to an unpublished work by Myburg 2016 et 16 al. from the urology department of Universitas Academic Hospital, Bloemfontein, Free State, South Africa, African men, compared with their European counterparts, had PCa associated with worse prognosis (i.e. Gleason score ≥ 8), higher mean PSA levels and more locally advanced stage, at presentation. These results are corroborated by previous studies on racial 17, 18, 19, 20, 21, 22 disparities in PCa presentation. Another unpublished audit of PCa cases from January 2019 to July 2019 at the same department revealed that curative treatment was possible in only about 10% (38 out of 366) of the cases, whereas 77% of PCa cases are localised, according to the National Cancer Institute, 23 United States. Risk factors that have been associated with PCa are either nonmodiable (e.g. increasing age, ethnicity, genetic factors and family history) or modiable, for example diet (increased intake of saturated animal fat and red meat, coffee consumption, lower intake of fruits, vegetables and vitamins), smoking, obesity, physical inactivity, infections and environmental exposure to chemicals or ionising radiation. Modiable risk factors are 9,14 mostly behavioural and lifestyle factors. In a review article to establish the determinants of PCa risk, stage at diagnosis and survival among AfricanAmerican men, poor socio-economic status, lack of social support and network and poor access to healthcare services were associated with unfavourable 24 outcome. In a United States study, it was concluded that separate PCa screening guidelines might be 25 benecial to the African-American population. More empirical and evidence-based studies may therefore be necessary among African men, who are more 26, 27, 28 susceptible to developing Pca. Unlike the nonmodiable risk factors, some of the modiable risk factors for PCa are community specic. Environmental exposure to chemicals such as pesticides, herbicides, chromium and cadmium is an important risk factor among African men in the Free State province, as many are employed in the agricultural and 29 mining industries. An understanding of communityspecic determinants of this disease and the risk factors associated with the stage and grade at diagnosis is an important step towards the development of relevant 30 health promotion interventions. Although population screening for PCa is currently not supported, once a patient deemed to belong in the high-risk category attends a healthcare facility, he should be considered for 31 screening through a shared decision process. Aim and objectives This study aimed to determine the prole of African men with PCa in the Free State province, South Africa. The primary objective was to identify their sociodemographic and background characteristics, common clinical features, risk factors for PCa, stage and grade of PCa disease. The secondary objective was to determine factors associated with the stage and grade of the disease at diagnosis. Materials and methods Study design This was a cross-sectional descriptive study describing the characteristic features of African men diagnosed with PCa in the Free State province of South Africa. Target population and sampling The target population was African men seen and diagnosed histologically with PCa at the urology and oncology units of Universitas Academic Hospital, a teaching hospital in the Free State province of South Africa. For the purpose of this study, 'African men' are dened as self-identied indigenous Black South African men. Using convenience sampling, all African men diagnosed histologically with PCa attending the urology and oncology clinics for follow-up over a period of just over six months (21 January 2021 to 31 July 2021) were included in the study. All patients of non-black races (including mixed race patients) were excluded from the study. Also, ve participants were excluded; three were nonconsenting while the other two were too weak to participate. In total, 341 participants were included in the study. UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE
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