29 Discussion Background characteristics of participants Age at diagnosis of PCa is one of the factors that contribute to poor health-related quality of life 35 outcomes for survivors. In this study, the median age at diagnosis was 66 years. This is in keeping with statistics from the American Cancer Society, where 60% of cases are diagnosed in men who are 65 years 36 or older and rare in men under 40 years. A recent retrospective study also found the average age at diagnosis to be 66 years among South African and 37 Nigerian men. Early-stage PCa may be asymptomatic, and as such, most men will only present when symptomatic, especially if there is no PCa screening in the public sector. Hence, there is still the likelihood for delayed presentation in our setting. Most men in this study are of the Sesotho cultural group. The ethnic differences shown in this study may be a reection of ethnic group distribution in the Free State province and not necessarily an indication of the prevalence of the disease across the various ethnic groups. Studies have suggested that ancestry may be 9, 26, 28 associated with PCa burden. Occupational exposure to carcinogenic agents such as pesticides, herbicides, chromium, cadmium, cutting uids and ionising radiation is not uncommon in the Free State province, where mining and agriculture are the predominant industries. There is an association 14, 38 between exposure to these agents and Pca. Selfreported exposure to herbicides and pesticides in this study is relatively low (4.7%) compared with mine exposure (30.2%). This may be because of a lack of awareness of their exposure to hazardous occupational agents. UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE
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