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Prostate cancer among black men is on the rise – UFS study

12 February 2024 | Story André Damons | Photo SUPPLIED

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.

This is according to a recent study by Dr Matthew Benedict, 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). 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.

This 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.

Underrepresentation of men's health issues

Dr Benedict says his study therefore sought to identify 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.

“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

The study highlights deficiencies in prostate cancer screening of black men in the Free State, and Dr Benedict said he anticipates receiving support to facilitate the implementation of the recommended strategies stemming from this research. Implementing the proposed targeted strategies designed for black men and their primary healthcare providers has the potential to elevate awareness and knowledge and ultimately enhance screening practices among black men.

News Archive

Bloemfontein's quality of tap water compares very favourably with bottled water

2009-08-04

The quality of the drinking water of five suburbs in Bloemfontein is at least as good as or better than bottled water. This is the result of a standard and chemical bacterial analysis done by the University of the Free State’s (UFS) Centre for Environmental Management in collaboration with the Institute for Groundwater Studies (IGS).

Five samples were taken from tap water sources in the suburbs of Universitas, Brandwag, Bain’s Vlei, Langenhoven Park and Bayswater and 15 samples were taken of different brands of still and unflavoured bottled water. The samples were analysed at the laboratory of the IGS, while the interpretation of the analysis was done by the Centre for Environmental Management.

“We wanted to evaluate the difference in quality for human consumption between tap water and that of the different brands of bottled water,” said Prof. Maitland Seaman, Head of the Centre for Environmental Management.

“With the exception of two samples produced by multinational companies at their plants in South Africa, the different brands of bottled water used for the study were produced by South African companies, including a local small-scale Bloemfontein producer,” said Prof. Seaman.

According to the labels, the sources of the water vary from pure spring water, to partial reverse osmosis (as an aid to standardise salt, i.e. mineral, content), to only reverse osmosis (to remove salts). (Reverse osmosis is a process in which water is forced under pressure through a pipe with minute pores through which water passes but no – or very low concentrations of – salts pass.)

According to Prof. Seaman, the analysis revealed some interesting findings, such as:

• It is generally accepted that drinking water should have an acceptable level of salt content, as the body needs salts. Most mineral contents were relatively higher in the tap water samples than the bottled water samples and were very much within the acceptable range of drinkable water quality. One of the bottled samples, however, had a very low mineral content, as the water was produced by reverse osmosis, as stated on the bottle. While reverse osmosis is used by various producers, most producers use it as an aid, not as a single method to remove nearly all the salts. Drinking only such water over a prolonged period may probably have a negative effect on the human physiology.

• The pH values of the tap water samples (8,12–8,40) were found to be slightly higher (slightly alkaline), like in all south-eastern Free State rivers (from where the water is sourced) than the pH of most of the bottled water samples, most of which are sourced and/or treated in other areas. Two brands of bottled water were found to have relatively low pH levels (both 4,5, i.e. acidic) as indicated on their bottles and as confirmed by the IGS analysis. The health implication of this range of pH is not significant.

• The analysis showed differences in the mineral content given on the labels of most of the water bottles compared to that found by IGS analysis. The possibility of seasonal fluctuation in content, depending on various factors, is expected and most of the bottling companies also indicate this on their labels. What was a rather interesting finding was that two pairs of bottled water brands claimed exactly the same mineral content but appeared under different brand names and were also priced differently. In each case, one of the pair was a well-known house brand, and the other obviously the original producer. In one of these paired cases, the house brand stated that the water was spring water, while the other (identical) “original” brand stated that it was spring water treated by reverse osmosis and oxygen-enriched.

• Nitrate (NO3) levels were uniformly low except in one bottled sample, suggesting a low (non-threatening) level of organic pollution in the source water. Otherwise, none of the water showed any sign of pollution.

• The bacterial analysis confirmed the absence of any traces of coliforms or E.coli in any of the samples, as was also indicated by the bottling companies. This is very reassuring. What is not known is how all these waters were sterilised, which could be anything from irradiation to chlorine or ozone treatment.

• The price of the different brands of bottled water, each containing 500 ml of still water, ranged between R3,99 and R8,99, with R5,03 being the average price. A comparison between the least expensive and the most expensive bottles of water indicated no significant difference in quality. In fact, discrepancies were observed in the most expensive bottle in that the amount of Calcium (Ca) claimed to be present in it was found to be significantly different from what the analysis indicated (29,6 mg/l versus 0,92 mg/l). The alkalinity (CaCO3 mg/l) indicated on the bottle was also found to differ considerably (83 mg/l versus 9,4 mg/l). The concentration of Total Dissolved Salts (TDS) was not given on the product.

“The preference for bottled water as compared to Bloemfontein’s tap water from a qualitative perspective as well as the price discrepancy is unjustifiable. The environmental footprint of bottled water is also large. Sourcing, treating, bottling, packaging and transporting, to mention but a few of the steps involved in the processing of bottled water, entail a huge carbon footprint, as well as a large water footprint, because it also requires water for treating and rinsing to process bottled water,” said Prof. Seaman.

Media Release
Lacea Loader
Deputy Director: Media Liaison
Tel: 051 401 2584
Cell: 083 645 2454
E-mail: loaderl.stg@ufs.ac.za
3 August 2009

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