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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

Official opening ceremony of the UFS Qwaqwa Campus
2006-02-15

Official opening ceremony of the UFS Qwaqwa Campus
11th February 2006 – Multipurpose Hall

Opening Speech:
Prof. Peter A. Mbati
Campus Principal

Successfully rising to the challenges of incorporations and mergers – developing a vibrant and academically stimulating satellite campus of the University of the Free State.

Thank you Mr. Program Director and good morning ladies and gentlemen.

I wish to once again welcome all of you to the official opening ceremony of the University of the Free State QQ campus.  Thank you for taking time to share with us an important date in our campus academic calendar.  I bring you greetings from our Rector and Vice Chancellor Prof. Frederick Fourie.

During such occasions we try and reflect on important matters that have affected us as an institution in the preceding year, commit ourselves to specific objectives for the current year, while planning for the proceeding year.

Today I shall be talking on Successfully rising to the challenges of incorporations and mergers – developing a vibrant and academically stimulating satellite campus of the University of the Free State’.

SRC inauguration
I would like to congratulate the SRC President and the entire SRC leadership for being elected into important positions of student leadership and authority. 

As a university we are proud of the quality of our student leadership on the Qwaqwa campus.  I am confident that you young leaders will rise to the challenges of your office and discharge your duties with diligence and without fear or favour.  That you will rise above your party affiliations and provide effective leadership to the entire student body on campus.
                              
Leadership is complex and requires you to be objective, just and fair in your approach to the many challenges that you will encounter.  You will be judged not by the populist decision that you take when confronted with difficult choices, but rather, on the wisdom that you exercise in reaching consensus in decision making processes.

The era when management and student leadership viewed each other with suspicion and as adversaries is long gone.  Management, academic and administrative staff, parents and students must have common agendas in as far the  quality growth and development of our university is concerned and to strive towards academic excellence.  I leave the challenge to you students, and more so to the inaugurated student leaders to define your agenda in achieving this noble objective.  I trust that you will make the right choices.

Brief history of incorporation
On the recommendations of the National Working Group of Higher Education, the Qwaqwa Campus of the then University of the North was incorporated into the University of the Free State on 1st January 2003.  We suddenly had to move from a campus that was originally semi-autonomous and with its own culture developed over almost 20 years, into a campus that had to operate as a fully integrated campus of the UFS, a 100 year old institution with its distinct culture.

Following incorporation, we not only had to continue with our core business of teaching, learning, research and community service, but we also had to engage in other important aspects such as exploring the most appropriate models of governance for the campus, encouraging dialogue and interactions at all levels between personnel at the different campuses with a view to developing trust between colleagues. And with the added dimensions such as participation in the transformation task team we in effect are at the fore front of developing a new institutional culture at the UFS and a truly South African University.

UFS Strategic objectives
The strategic and transformation priorities of the University of the Free State for 2006 – 2008 as approved by the Executive Management at its retreat in January 2006 are:

  • Quality and Excellence
  • Equity, diversity and redress
  • Financial sustainability
  • Regional co-operation and engagement

Central to this priority is the integration of the Qwaqwa campus as a valuable constituent part of the UFS, and the strategic reconfiguration of the campus in order that the UFS can play a meaningful role in regional engagement and development.

  • National leadership

The five strategic objectives cannot be viewed in isolation and run simultaneously and in concert with each other. 

The Question must therefore be what we on the QQ campus, staff and students, parents and our broader community are willing to do to achieve these strategic objectives. The reconfiguration and strategic planning of this campus, and therefore its success, must be a collaborative effort between colleagues at QQ and on the main campus.  We must all be ready to work together, to plan together, to shoulder responsibilities together and sometimes, to share the pain and disappointments together. 

The second question must therefore be: are we prepared to go that extra mile for our campus to ensure that we claim our rightful stake within the ranks of well respected academic institutions of higher learning in this country?  At this point in its history this campus requires committed men and women from across the cultural spectrum who appreciate the challenges ahead of us and who are ready to give of their best and to constructively engage at all levels to make this dream a reality.  Because this dream is possible and this dream will be realized!

Quality and Excellence (1st strategic objective)

As mentioned by the Rector in his speech at the official opening ceremony of the university on the main campus on Friday 3rd February, the university will in 2006 pay extra attention to Quality and Excellence.  This is informed by the Higher Education Quality Committee’s (HEQC) institutional audit which is scheduled to take place this year.  Our university as well as several other HEI’s will be subjected to this audit.  This will call for a lot of hard work on your part in preparation for a successful audit and in this regard therefore I request for your cooperation.

As a further step in confirming our commitment to quality and excellence, we have simultaneously introduced on the QQ campus and the main campus workshops on performance management systems to a cohort group.  This will be expanded in 2006 to a wider group of managers on the QQ campus to include among others all Program Heads and Subject Heads. PMS is an invaluable tool for fair, effective and efficient management of a very important resource on campus – the human resource.  Benefits of PMS include among others:

  • Instilling and enriching a culture of performance management (quality assurance) as an integral part of the day to day functioning of staff at the campus
  • Improving staff performance through mentoring, development and training

Tri campus project
One of the more important projects that we as a university undertook in 2005 was the Tri Campus Project which was coordinated by the Free State Higher Education Consortium (FSHEC) through Niel Butcher and Associates consultants.

The Tri-Campus project focused on the strategic planning for higher education campuses in the Free State that have been incorporated with UFS and CUT during the reshaping of the South African higher education landscape. The Bloemfontein Vista campus and the Qwaqwa campus of the University of the North were incorporated with the UFS, and the Welkom Vista campus with the CUT.

The planning process involved a range of research and consultation activities during the course of 2005. This included:

  • Conducting situational analyses of the Qwaqwa campus during which staff and students were widely consulted;
  • Consulting with the campus and with a range of stakeholders in the sub-region
  • Review of the Free State Provincial Growth and Development Strategy and Integrated Development Plans (IDPs) of the regions and other research of relevance to the sub-regions, province and country.

An operational framework for the reconfiguration of the campus with a range of possible Program Qualification Mixes has been produced.  In December 2005, the Rector, the Vice Rector Academic Planning Prof. Magda Fourie and I discussed this document with senior members of the DoE in Pretoria, and we will soon be meeting with the National Minister of Education Me Naledi Pandor for her guidance and to seek support in the further refinement of the document and subsequent implementation.

Recapitalization
This year a further R 6 M has been budgeted for recapitalization.  In about two weeks time the third of phase of renovations on campus will commence and attention will be given to the administration building, the humanities and the outstanding work in the lecture hall complex.  There- after the library, sciences and education buildings will follow.  As you will recall a substantial portion of the R 8.4 million in 2005 was used to upgrade the student residences and the lecture hall complex.

I am certain that the renovations and upgrading of our infrastructure and physical facilities including landscaping will create an enabling environment for you to enjoy your work and studies on this campus.

Renovations come with some measure of inconveniences and I therefore wish to request for your patience and support during this period.

Closing remarks
There is a heightened spirit of optimism on what the future holds for this campus.  This is evident when I talk to a large cross section of staff and students of this campus – and I therefore invite all of you to come and be partners with us on this journey of optimism and hope of what the future holds for the UFS – QQ campus.

Thank you and God bless!

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