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12 February 2024 | Story André Damons | Photo SUPPLIED
Dr Matthew Benedict
Dr Matthew Benedict, Senior Lecturer and Medical Specialist in the Department of Family Medicine, Faculty of Health Sciences at the University of the Free State.

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

UFS’ position on student politics
2011-09-01

The University of the Free State (UFS) welcomes politics on its campus. It especially invites students to participate in all the political activities on campus, ranging from seminars and debates on national and provincial politics, and organization within party political structures. Earlier the year, in the run-up to the Local Government Elections, a programme was run on campus with all political parties participating in public and radio debates with students on political issues.

A university must be a place for all kinds of ideas and organizations---social, cultural, religious, academic and, yes, political. The perception that the UFS has “banned” politics is simply not true, nor is it possible within a constitutional democracy.
 
The University of the Free State once again invites SASCO and any other political groupings that have not yet registered to participate in campus life, to do so as soon as possible. It is important to the UFS that all student bodies enjoy full participation in campus life, and that there exists a vibrant and exciting political life on the campus alongside academic, social, cultural and religious life.
 
The Student Representative Council (SRC) Elections at the UFS has been constituted on independent candidacy and non-party-political basis. This is a decision crafted and recommended by the Broad Student Transformation Forum, whose members are elected by students, and approved for implementation by the highest authority of the university, the Council. The decisions of the Student Forum entails that all students can nominate individuals for a variety of student leadership positions, which includes nomination for elective portfolios in the SRC elections, but also within nine sub-councils that hold ex-officio seats on the SRC.
 
The old system which restricted student leadership to representation on a party-political basis only (DA, ANC, Freedom Front Plus etc) no longer exists.
 
This decision of the Student Forum ensures that the rights of all students to directly elect their representatives are protected, and that the SRC in fact represents the student body as a whole and not particular interest groups alone. This decision enables ALL students to stand for and participate in campus politics in the SRC elections, though not on a party political ticket. In the 2011 SRC Elections, for example, SASCO members were indeed mandated by its local branch to stand as candidates for various elected positions, as did other political parties such as the DA Student Organisation, a development which the university welcomes. 
 
Most importantly, the UFS insists that all students participate in university life with respect for the rights of all students, irrespective of their social beliefs or political commitments. The UFS insists that no student or student grouping acts to disrupt campus life or insult university staff or denigrate fellow students on grounds of race, religion, language, gender, etc. This is very important to the UFS as it works to build a non-racial culture that respects our common humanity. Our students must learn that democracy and decency go hand in hand, and that part of learning at a university, is to learn to differ without resorting to a language of derision.
 
In short, the University of the Free State warmly welcomes full participation in politics, as in other spheres of student life, on all three its campuses.
 
Statement by Prof. Jonathan Jansen, UFS Vice-Chancellor and Rector.

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