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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

PhD students’ voices reverberate across Africa and beyond
2014-01-14

 

Noel Ndumeya, Tinashe Nyamunda, Ivo Mhike and Anusa Daimon
Photo: Hannes Pieterse
The Centre of Africa Studies (CAS) has been recruiting the best young scholars from across the SADC region – with magnificent success. In the span of six months, four PhD students have excelled both on the African continent and abroad.

Anusa Daimon, Noel Ndumeya, Ivo Mhike and Tinashe Nyamunda – the names of these distinguished students. Set against the backdrop of global excellence and competition, they have been awarded several positions at conferences and already published world-wide.

Anusa Daimon’s PhD studies at the CAS focuses on Malawian migrants and their descendants in Southern Africa. It explores issues of identity construction and agency among this group.

Since his arrival at the CAS, Daimon has won two fully-funded awards to attend international conferences and workshops. He was invited to attend the Young African Scholars Conference at Cambridge University in the UK. He also went to Brazil to the IGK Work and Human Lifecycle in Global History Summer Academy. This workshop explored the historical and modern meanings and practices of work in terms of ‘freedom’ and ‘unfreedom’.

Noel Ndumeya holds a special interest in environmental history and the aspects of conservation and conflict. His PhD hones in on land and agrarian studies with specific focus on South Eastern Zimbabwe.

Ndumeya has won an award from the African Studies Association United Kingdom (ASAUK). This earned him an invitation to Nairobi, Kenya, to work with an editor from the Journal of Southern Africa Studies (JSAS).

Ivo Mhike’s research specialises in youth culture and their relationship with the state. In his PhD he uses juvenile delinquency as a window towards an analysis of social constructs of youth behaviour. This includes youth policy and their institutional and administrative links to the state.

Mhike has been invited to attend the CODESRIA Child and Youth Institute in Dakar, Senegal, with the theme: Social Protection and the Citizen Rights of Vulnerable Children in Africa.

Tinashe Nyamunda specialises in African Economic History. His PhD thesis is entitled, “The State and Finance in Rhodesia: A study of the evolution of the monetary system during the Unilateral Declaration of Independence (UDI), 1965–1979”.

Under the direction of his primary supervisor, Prof Ian Phimister and his secondary supervisor, Dr Andrew Cohen, four of his papers have been accepted for publication. Nyamunda also received sponsorship from the Rector’s Office for an edited book collection of which he is the leading author. The book focuses on the many aspects of Zimbabwe’s blood diamonds.

Recently, Nyamunda has contributed papers at conferences in Botswana and Scotland and attended a workshop at Lund University in Sweden. He has also received an invitation from Germany and Oxford to present some chapters of his PhD thesis.

“The centre has provided the best working environment any PhD student can dream of,” Nyamunda said. He continued to remark that the opportunities Prof Jonathan Jansen has created opened up immense possibilities for them.

“Given these fruitful experiences in just a year at the university,” Nyamunda said,” imagine what can be accomplished given the resources and environment availed by the institution.” The prospects after his PhD studies looks bright, he concluded, because of the opportunities provided by the UFS.

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