27 Measurement, data collection and the questionnaire Data were collected using a self-administered survey questionnaire. Parameters in the questionnaire were 17, 32, 33 adapted from similar studies that aimed to understand the prole of patients with PCa. Patients diagnosed with PCa and attending the urology and oncology clinics for follow-up visits were requested to complete the questionnaire. Adequate time was allowed for participants to read and understand the study information and consider their consent prior to participation. Upon their consent, the researcher administered the questionnaires to them. Completed questionnaires were collected the same day and immediately kept secured. The questionnaire consisted of two sections, A and B. Section A enquired about participants' sociodemographic and background details, that is, age, cultural group, level of education, occupation (including mine workers, exposure to pesticides and herbicides), relationship status and residential area. The following data pertained to the participants' PCa, that is, events leading to PCa diagnosis, PCa symptoms reported, duration between onset of symptoms and presentation, previous PCa screening, year of diagnosis, duration between urology appointment and PCa diagnosis, duration between PCa diagnosis and treatment initiation, PCa history among rst-degree relatives, medical comorbidities, prior history of sexually transmitted diseases (STDs), cancer stage at diagnosis, Gleason score, recalled history (from 20 years old) of physical activities, diet, body size, exposure to sunlight and smoking. The questionnaire was translated into the languages spoken most commonly in the area, that is, Sesotho 34 and IsiZulu. A trained research assistant uent in these local languages helped with further clarication of questions to the participants who required such help. Information unknown to the participants, such as cancer stage, Gleason score and other technical features, were obtained from Meditech (Universitas Adacemic Hospital electronic clinical record system) and recorded on the questionnaire by the researcher. Steps taken to minimise measurement error Case and data duplication was prevented by using a colour-coding system where the front cover of a participant's case record was marked by the researcher for easy identication of those who had already participated. Content validity of questionnaire The questionnaire was adapted from previous similar 17, 32, 33 peer- reviewed studies. A Health Sciences Faculty evaluation committee consisting of consultant family physicians, a urologist, medical educators, a professional nurse and a biostatistician subjected the questionnaire to review and approval. Pilot study The questionnaire (using the applicable language version) was pretested on the rst 10 participants (in succession) to ensure that the questions were balanced and correctly constructed and that the crucial information would be obtained. The 10 piloted questionnaires were included in the study since no signicant changes arose from the pilot study. Data analysis The data were analysed by the rst author, using SAS version 9.3 (Cary, NC: SAS Institute Inc.). Descriptive statistics were used for continuous variables, while frequencies and percentages were computed for categorical data. Association between variables were assessed using chi-squared or Fisher's exact tests. A p-value of < 0.05 was taken to be signicant. Ethical considerations The study was approved by the Health Sciences Research Ethics Committee (HSREC) of the University of the Free State (ref. no. UFS-HSD2020/1481/2411). Permission to conduct the study was granted by the Head of the Free State Department of Health. Following a detailed description of the study, signed informed consent was obtained from each participant prior to their participation in the study. The voluntary nature of participation and the right to refuse to participate or to withdraw at any time were also explained to the participants. The self-administered questionnaire was anonymous, as no identifying information was recorded on any of the documents. Results Sociodemographic and background characteristics of participants Table 1 summarises the demographic data of the 341 participants. The median age of the participants at diagnosis was 66 years (range 40–93 years). Most patients were in their 70s (n = 162; 47.5%) while 68 (20.0%) were in their 50s. The majority of the participants (n = 298, 87.4%) had symptoms prior to the diagnosis of PCa. Of the 298 participants who had symptoms, 230 (77.2%) sought medical help themselves, and 67 (22.5%) were persuaded by family members, while one (0.3%) participant was advised on a PSA test by his doctor. The majority of the participants had multiple symptoms. The top 10 symptoms among the participants were dysuria (n = 216, 72.5%), poor stream (n = 203, 68.1%), urinary frequency (n = 129, 43.3%), nocturia (n = 98, 32.9%), urinary hesitancy (n = 78, 26.2%), frequent lower back pain (n = 75, 25.2%), impotence (n = 72, 24.2%), incomplete voiding (n = 47, 15.8%), dribbling of urine (n = 33, 11.1%) and urinary retention (n = 27, 9.1%). Most patients presented to a healthcare facility within 1 year of symptoms (n = 238; 79.8%). Only 76 (22.3%) participants had ever heard of PCa prior to diagnosis. Of these 76 participants, 36 (47.4%) had PCa screening in the past, by either PSA alone or in combination with digital rectal examination (DRE). UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE
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