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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

Gender bias still rife in African Universities

2007-08-03

At the lecture were, from the left: Prof. Magda Fourie (Vice-Rector: Academic Planning), Prof. Amina Mama (Chair: Gender Studies, University of Cape Town), Prof. Engela Pretorius (Vice-Dean: Humanties) and Prof. Letticia Moja (Dean: Faculty of Health Sciences).
Photo: Stephen Collett

Gender bias still rife in African Universities

Women constitute about 30% of student enrolment in African universities, and only about 6% of African professors are women. This is according to the chairperson of Gender Studies at the University of Cape Town, Prof Amina Mama.

Prof Mama was delivering a lecture on the topic “Rethinking African Universities” as part of Women’s Day celebrations at the University of the Free State (UFS) today.

She says the gender profile suggests that the majority of the women who work in African universities are not academics and researchers, but rather the providers of secretarial, cleaning, catering, student welfare and other administrative and support services.

She said that African universities continue to display profound gender bias in their students and staffing profiles and, more significantly, are deeply inequitable in their institutional and intellectual cultures. She said women find it difficult to succeed at universities as they are imbued with patriarchal values and assumptions that affect all aspects of life and learning.

She said that even though African universities have never excluded women, enrolling them presents only the first hurdle in a much longer process.

“The research evidence suggests that once women have found their way into the universities, then gender differentiations continue to arise and to affect the experience and performance of women students in numerous ways. Even within single institutions disparities manifest across the levels of the hierarchy, within and across faculties and disciplines, within and between academic and administrative roles, across generations, and vary with class and social background, marital status, parental status, and probably many more factors besides these”, she said.

She lamented the fact that there is no field of study free of gender inequalities, particularly at postgraduate levels and in the higher ranks of academics. “Although more women study the arts, social sciences and humanities, few make it to professor and their research and creative output remains less”, she said.

Prof Mama said gender gaps as far as employment of women within African universities is concerned are generally wider than in student enrolment. She said although many women are employed in junior administrative and support capacities, there continues to be gross under-representation of women among senior administrative and academic staff. She said this disparity becomes more pronounced as one moves up the ranks.

“South African universities are ahead, but they are not as radically different as their policy rhetoric might suggest. A decade and a half after the end of apartheid only three of the 23 vice-chancellors in the country are women, and women fill fewer than 30% of the senior positions (Deans, Executive Directors and Deputy Vice-Chancellors)”, she said.

She made an observation that highly qualified women accept administrative positions as opposed to academic work, thus ensuring that men continue to dominate the ranks of those defined as ‘great thinkers’ or ‘accomplished researchers’.

“Perhaps women simply make realistic career choices, opting out of academic competition with male colleagues who they can easily perceive to be systematically advantaged, not only within the institution, but also on the personal and domestic fronts, which still see most African women holding the baby, literally and figuratively”, she said

She also touched on sexual harassment and abuse which she said appears to be a commonplace on African campuses. “In contexts where sexual transactions are a pervasive feature of academic life, women who do succeed are unlikely to be perceived as having done so on the basis of merit or hard work, and may be treated with derision and disbelief”, she said.

She, however, said in spite of broader patterns of gender and class inequality in universities, public higher education remains a main route to career advancement and mobility for women in Africa.

“Women’s constrained access has therefore posed a constraint to their pursuit of more equitable and just modes of political, economic and social development, not to mention freedom from direct oppression”, she said.

Prof Mama concluded by saying, “There is a widely held agreement that there is a need to rethink our universities and to ensure that they are transformed into institutions more compatible with the democratic and social justice agendas that are now leading Africa beyond the legacies of dictatorship, conflict and economic crisis, beyond the deep social divisions and inequalities that have characterised our history”.

She said rethinking universities means asking deeper questions about gender relations within them, and taking concerted and effective action to transform these privileged bastions of higher learning so that they can fulfil their pubic mandate and promise instead of lagging behind our steadily improving laws and policies.

Media Release
Issued by: Mangaliso Radebe
Assistant Director: Media Liaison
Tel: 051 401 2828
Cell: 078 460 3320
E-mail: radebemt.stg@ufs.ac.za
02 August 2007

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