Ofori et al. African Journal of Urology (2025) 31:41 https://doi.org/10.1186/s12301-025-00512-y REVIEW Open Access © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/. African Journal of Urology The intersection of culture and prostate cancer care in Sub‑Saharan Africa: a systematic review Benedict Ofori1,2, Kwadwo Fosu1,2, Anastasia Rosebud Aikins1,2* and Kwabena Amofa Nketia Sarpong1,2*  Abstract  Background  In sub-Saharan Africa, prostate cancer poses a growing burden, with projections indicating a near dou- bling of deaths by 2040. Cultural beliefs and stigmas surrounding prostate cancer can deter men from seeking timely medical care until the disease has advanced. This systematic review explores the intersection of cultural influences on prostate cancer care in sub-Saharan Africa, identifying barriers and facilitators to improving health outcomes for sub-Saharan African men. Method  We searched PubMed, ScienceDirect, Web of Science, and Scopus from 2000 to 2023 for studies and reports focusing on cultural beliefs, health-seeking behaviors, traditional medicine for prostate cancer care, and healthcare access related to prostate cancer care in sub-Saharan Africa. Additionally, we used data from the African Cancer Regis- try and the Global Cancer Observatory to gather information on prostate cancer cases. Results  We included 34 studies in this review. These studies revealed that there are diverse cultural perceptions influencing attitudes to prostate cancer, such as associating it with spiritual causes or issues of masculinity, leading to stigma and delays in seeking medical care in sub-Saharan Africa. Mostly, men perceive prostate cancer screening negatively due to fears of discomfort, social stigma, fatalism, and misconceptions about the causes and outcomes of the disease. Effective strategies for improving awareness about prostate cancer include community engagement, media outreach, healthcare provider education, and enhancing accessibility to screening services, particularly in rural areas. Conclusion  This study highlights the significant impact of cultural beliefs on prostate cancer care-seeking behaviors in sub-Saharan Africa and uncovers widespread misconceptions and stigmas that impede timely diagnosis and treat- ment. Our findings show the urgent need for culturally tailored interventions to increase awareness, correct mis- conceptions, and diminish the stigma associated with prostate cancer in the region. This is essential for enhancing prostate cancer outcomes and addressing the anticipated increase in cases. Keywords  Prostate cancer, Sub-Saharan Africa, Cultural beliefs, Awareness programs, Healthcare access, Stigma 1 � Background Globally, 1.6  million men are diagnosed annually with prostate cancer (PCa) and it is the most prevalent cancer among men in over 100 countries, resulting as the highest cause of cancer-related mortality in 50 countries [8, 35, 52, 54]. The available data shows that the total estimated PCa cases in 2020 were 77,300 in over 40 sub-Saharan African (SSA) countries, and the current number of cases has risen to 103,050 making it the leading cause of cancer *Correspondence: Anastasia Rosebud Aikins araikins@ug.edu.gh Kwabena Amofa Nketia Sarpong kansarpong@ug.edu.gh 1 Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana 2 West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana http://creativecommons.org/licenses/by/4.0/ http://crossmark.crossref.org/dialog/?doi=10.1186/s12301-025-00512-y&domain=pdf Page 2 of 17Ofori et al. African Journal of Urology (2025) 31:41 in men in the region [9, 20, 51]. In SSA alone, the Insti- tute for Health Metrics and Evaluation in 2013 found that the number of years lost due to disability from PCa rose from 100,200 in 1990 to 219,700 in 2010 with the number of deaths increasing from 5600 to 12,300 during the same time frame [3]. Projections suggest that PCa deaths will almost double by 2040 in SSA [36]. The exact cause of PCa is unknown, but risk factors such as age, race, family history, and diet can increase the likelihood of developing PCa [34]. In SSA, PCa diagnosis often relies on clinical evaluation, digital rectal examina- tion (DRE), prostate-specific antigen (PSA) testing, biop- sies, and imaging, though accessibility, cost, and cultural stigmas pose significant barriers [36, 50]. When detected early, PCa often has an excellent prog- nosis. Barring metastasis, most individuals diagnosed with PCa have a very high chance of surviving at least five years [4]. However, due to the lack of diagnostic capac- ity in SSA coupled with cultural factors preventing men from seeking early PCa care, there is an urgent need to address the inequities in PCa care in the region [36, 52]. Black men, particularly in SSA, are significantly under- represented in PCa research [33]. African American men already face low clinical trial participation [33, 62], and African men in SSA are further excluded due to limited research diversity and structural and cultural barriers [43]. Studies typically draw participants from clinical set- tings, excluding men who avoid formal healthcare [25]. This exclusion impedes the collection of meaningful data on PCa burden, risk factors, and care outcomes, making it difficult to design effective, context-sensitive interven- tions [39, 52]. Cultural beliefs and stigma play a central role in delayed help-seeking behavior, often leading men to present only at advanced disease stages [10, 60]. This systematic review, therefore, explores how cultural beliefs and stig- mas influence PCa care in SSA and highlights culturally sensitive interventions to improve awareness, reduce stigma, and enhance early detection and treatment. 2 � Methodology We conducted a comprehensive literature search using four databases (PubMed, ScienceDirect, Web of Science, Scopus), one registry (the African Cancer Registry), and data from the Global Cancer Observatory (GLOBO- CAN) following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [53]. We retrieved studies published in English from 2000 to 2023. We sought studies focused on cultural beliefs, health-seeking behaviors, traditional medicine, and healthcare access related to PCa in SSA. We used a combination of the following search terms to capture relevant literature: Prostate cancer AND cultural beliefs AND Africa, Prostate cancer AND health-seeking behav- ior AND Africa, Prostate cancer AND traditional medi- cine AND Africa, Prostate cancer AND treatment AND stigma AND Africa, Prostate cancer AND diagnosis AND healthcare access AND Africa. 2.1 � 2.1 Inclusion criteria Studies were included if they reported original empiri- cal research, whether qualitative, quantitative, or mixed methods, focused on PCa in SSA. Eligible studies spe- cifically examined aspects such as awareness, diagnosis, treatment, help-seeking behavior, or care experiences related to PCa. Only peer-reviewed articles published between January 2000 and December 2023, written in English, and involving populations residing within SSA countries were considered. 2.2 � 2.2 Exclusion criteria We excluded publications that did not present original data, including editorials, commentaries, opinion pieces, conference abstracts, short communications, and both narrative and systematic reviews. Studies focusing on African or African American populations outside SSA, as well as non-peer-reviewed literature such as theses, reports, or dissertations, were also excluded. Addition- ally, articles not published in English or not available in full text were excluded. 2.3 � 2.3 Quality assessment A formal standardized quality assessment tool was not used; however, a set of predefined criteria was applied to ensure the inclusion of high-quality studies. All duplicate studies were identified and removed using Mendeley Ref- erence Manager. The abstracts of the remaining articles were independently screened by two authors (BO and KF) for relevance and consistency in study design, data collection, and analysis. Studies were included based on the following criteria: clear articulation of study objectives, use of appropriate and well-defined study populations, transparent description of data collection methods, and presence of empirical data relevant to PCa and cultural or health-seeking behaviors in SSA. Redun- dant publications, which were defined as multiple reports from the same authors, population, or region within the same year, were excluded to prevent duplication. Dis- crepancies in the selection process were resolved through discussion and consensus between the two reviewers (BO and KF). 2.4 � 2.4 Data extraction Two authors (BO and KF) independently screened titles and abstracts followed by full-text reviews to extract data from the included studies. We sought data Page 3 of 17Ofori et al. African Journal of Urology (2025) 31:41 on papers that had reported study characteristics, par- ticipant demographics, cultural aspects, and outcomes of PCa screening and care in SSA. 3 � Results 3.1 � Overview From the combined search of four databases (PubMed, ScienceDirect, Web of Science, Scopus), the African Cancer Registry, and data from the Global Cancer Observatory (GLOBOCAN), we identified 34 relevant studies for this review (Fig. 1). The studies included in this review were mainly conducted in SSA countries namely, Burkina Faso, Cameroon, Ghana, Kenya, Nige- ria, South Africa, Tanzania, Uganda, and Zimbabwe. These studies were analyzed according to the inclusion and exclusion criteria. 3.2 � Educational background of screened men The educational levels of men screened for PCa var- ied across the included studies. Primary education was the most common level of schooling, with a study in Free State in South Africa reporting up to 75% of par- ticipants having only primary education [49] and 44.3% in the Kazo district of Uganda [47]. In contrast, sec- ondary education was more prevalent in other regions, with 46.4% to 70% of men in Kenya, Tanzania, Nigeria, and Zimbabwe completing secondary school [2, 37, 42, 45]. The proportion of men with tertiary education was relatively low, ranging from 6.4% to 29.5%, [46, 65] with some exceptions, such as a Ghanaian study where 90.6% of participants had university-level education [67]. Addi- tionally, a notable percentage of participants had no for- mal education, with figures reaching 25% in Makueni county in Kenya [46] and 60% in Bamenda, Cameroon [26] although these geographical areas were urban. These findings highlight that most men undergoing PCa screening in SSA have lower levels of formal education, Fig. 1  Flow diagram of literature search strategy and results Page 4 of 17Ofori et al. African Journal of Urology (2025) 31:41 which may impact PCa awareness, screening uptake, and health-seeking behaviors. 3.3 � Prevalence and incidence rates The prevalence and incidence rates of PCa in SSA exhibit significant regional variations. Data from GLOBOCAN provided specific incidence rates for PCa across vari- ous SSA countries. The estimated total number of new PCa cases in 2022 was 103,050 representing 20.4% of all cancer cases in males in the region [20]. This number is projected to increase to 196,021 by 2040 with a percent- age increase of 90.2%, higher than all cancer projections globally, reinforcing PCa as the leading cause of cancer among men in this region [21]. Notably, countries such as Chad, Côte d’Ivoire, and Sierra Leone reported higher incidence rates compared to other nations in the region based on total cancer cases in each country (Fig.  2). Globally, SSA shows one of the fastest-growing rates of PCa. [66]. 3.4 � Cultural beliefs and attitudes towards prostate cancer screening in Sub‑Saharan Africa Common cultural beliefs and myths about PCa may influence men’s understanding and attitudes toward the disease [18, 19, 42, 65]. The studies identified in the review show that sometimes in SSA, PCa is associated with spiritual causes or notions of masculinity, contrib- uting to the stigma surrounding the condition. In some communities, discussing prostate health remains uncom- mon, potentially delaying medical consultations. Among the 16 studies on cultural perceptions included in this review as shown in Table  1, two reported beliefs that PCa could result from lack of sex- ual activity, while others associate PCa risk with hav- ing multiple sexual partners or early sexual activity [42, 48]. This belief was more common among men with lower education levels and had deep roots in religious beliefs, as seen in Gatundu North and Kiambu Sub- counties in Kenya and Kampala in Uganda, where most Fig. 2  Prostate cancer prevalence among men in sub-Saharan Africa (2022): countries with ≥ 25% total cancer cases. Data obtained from [21]. Map created at https://​www.​mapch​art.​net/ under a creative commons attribution-shareAlike 4.0 international license (CC BY-SA 4.0) https://www.mapchart.net/ Page 5 of 17Ofori et al. African Journal of Urology (2025) 31:41 Ta bl e  1  Su m m ar y of s tu di es o n so ci o- de m og ra ph ic c ha ra ct er is tic s an d cu ltu ra l b el ie fs re ga rd in g pr os ta te c an ce r s cr ee ni ng in s ub -S ah ar an A fri ca n co un tr ie s Co un tr y an d ge og ra ph ic re gi on St ud y de si gn Pa rt ic ip an t c ha ra ct er is tic s Sa m pl e si ze Cu ltu ra l b el ie fs a nd p er ce pt io ns A ut ho r( s) re fe re nc es So ut h A fri ca , L im po po P ro vi nc e H er m en eu tic p he no m en ol og y de si gn Bl ac k m en a ge d 67 –8 5  ye ar s; th e  m aj or ity (7 5% ) h ad o nl y  pr im ar y sc ho ol e du ca tio n. M os t w er e ei th er  re tir ed (6 5% ) o r o n  a pe ns io n (3 0% ). A  s ig ni fic an t p ro po r- tio n (8 0% ) w er e m em be rs o f t he  Z io n C hr is tia n C hu rc h 20 Re lig io us b el ie fs a nd  p ra ct ic es p la ye d a  m aj or ro le in  c op in g w ith  P Ca , w ith  th e  m aj or ity re ly in g on  fa ith , p ra ye r, an d  ch ur ch s up po rt . N ot ab ly , a ll pa rt ic i- pa nt s (1 00 % ) r el ie d on  p ra ye r, an d  so m e tr an si tio ne d fro m  tr ad iti on al h ea lin g to  C hr is tia n pr ac tic es [4 9] So ut h A fri ca , F re e St at e A na ly tic al c ro ss -s ec tio na l s ur ve y M en a ge d 40 –4 9  ye ar s (5 7. 8% ), m ai nl y Se so th o (4 7. 8% ), an d  pr ed om in an tly re si di ng in  ru ra l a re as (7 9. 4% ). Ed uc a- tio na l l ev el s sh ow ed 2 8. 0% c om pl et ed G ra de 1 2, a nd  1 5. 7% h ad te rt ia ry e du ca - tio n. M os t ( 73 .8 % ) d id n ot  h av e he al th in su ra nc e. In co m e so ur ce s in cl ud ed em pl oy m en t ( 39 .3 % ), se lf- em pl oy m en t (2 2. 1% ), an d  go ve rn m en t g ra nt s (2 0. 1% ), w ith  5 4. 0% e ar ni ng b el ow  R 50 0 (U SD 27 5. 5) m on th ly . R el at io ns hi p st at us : 48 .6 % m ar rie d, 1 9. 5% s in gl e. A  fa m ily h is - to ry o f c an ce r w as  n ot ed in  1 8. 8% 38 9 Pa rt ic ip an ts e xh ib ite d lo w fa ta lis tic be lie fs (m ea n sc or e: 2 .0 5) a nd  m in i- m al fe ar o r a pp re he ns io n to w ar d  PC a an d  sc re en in g (m ea n sc or e: 2 .2 5) . Th ey d em on st ra te d a  m od er at e be lie f in  th e  be ne fit s of  s cr ee ni ng (m ea n sc or e: 2 .6 9) a nd  re po rt ed e xp er ie nc - in g m od er at e so ci al in flu en ce (m ea n sc or e: 2 .9 0) fr om  b ot h  fa m ily m em be rs an d  he al th ca re p ro vi de rs . T he y en co un - te re d fe w s itu at io na l b ar rie rs a nd  h ad a  m od er at e pe rc ei ve d ris k of  P Ca . Kn ow le dg e ab ou t P Ca c am e fro m  v ar io us so ur ce s, in cl ud in g  he al th ca re p ro vi d- er s an d  th e  m ed ia , h ig hl ig ht in g a  hi gh de m an d fo r a dd iti on al in fo rm at io n on  th e  su bj ec t [6 ] So ut h A fri ca Ex pl or at or y- de sc rip tiv e qu al ita tiv e m et ho do lo gy Bl ac k m al e pa rt ic ip an ts a ge d 46 to  7 6, al l w ith  a n  EC O G p er fo rm an ce s ta tu s of  1 a nd  lo ca lly a dv an ce d PC a, ra ng in g fro m  lo w to  h ig h gr ad e, w ith  P SA le ve ls be tw ee n  26 5 an d  14 86  n g/ m l. T hr ee tr av el le d fro m  a no th er p ro vi nc e fo r t re at - m en t, w hi le  m os t l oc al s liv ed in  d is ta nt to w ns hi ps 9 Pa rt ic ip an ts e xp re ss ed fe el in gs o f s ha m e an d  em ba rr as sm en t a bo ut  th e  ill - ne ss d ue to  s oc ie ta l s tig m a an d  a  la ck of  u nd er st an di ng a bo ut  P Ca . T he re w as  a  p re va le nt n ot io n of  s el f-b la m e fo r l at e di ag no si s du e to  ig no ra nc e ab ou t t he  d is ea se . T he a ss oc ia tio n of  p ro st at e is su es w ith  m as cu lin ity le d to  a  re lu ct an ce to  d is cu ss s ym pt om s an d  a  re fu sa l b y  so m e to  s ee k tr ea t- m en t, pr io rit iz in g pe rc ei ve d m an ho od ov er  h ea lth . P ar tic ip an ts n ot ed th at  P Ca is  s ee n as  a  ‘s ile nt k ill er ,’ a nd  w er e w or rie d ab ou t h ow  th ey w er e go in g to  g et c ur ed if  th ey c on tr ac te d th e  di se as e [5 7] Page 6 of 17Ofori et al. African Journal of Urology (2025) 31:41 Ta bl e  1  (c on tin ue d) Co un tr y an d ge og ra ph ic re gi on St ud y de si gn Pa rt ic ip an t c ha ra ct er is tic s Sa m pl e si ze Cu ltu ra l b el ie fs a nd p er ce pt io ns A ut ho r( s) re fe re nc es G ha na , A sh an ti re gi on C ro ss -s ec tio na l q ua nt ita tiv e de si gn Fe m al e pa rt ic ip an ts (m ea n ag e  =  4 5. 02  ±  1 0. 66  y ea rs ), pr ed om in an tly C hr is tia n (9 1. 75 % ) a nd  A ka n (8 3. 50 % ). A bo ut h al f o f t he  p ar tic ip an ts (5 2. 5% ) h ad co m pl et ed p rim ar y sc ho ol e du ca tio n. A ls o, a bo ut  2 9. 5% h ad a ch ie ve d hi gh er ed uc at io n de gr ee w hi le  a bo ut  2 0. 25 h ad no  fo rm o f e du ca tio n 40 0 Th e m aj or ity o f p ar tic ip an ts (8 7. 75 % ) be lie ve d th at  e ve ry m an c ou ld d ev el op PC a, w ith  9 0. 25 % d is ag re ei ng th at  P Ca is  a  s pi rit ua l d is ea se . A  s ig ni fic an t p ro po r- tio n (6 6. 00 % ) d is ag re ed th at  it is  a  fa m ily di se as e, w hi le  n ea rly a ll pa rt ic ip an ts ag re ed th at  e ar ly d ia gn os is c an le ad to  a  c ur e. A dd iti on al ly , a bo ut  o ne -t hi rd be lie ve d th at  n ot hi ng c ou ld b e do ne to  s av e  a PC a pa tie nt [6 5] G ha na , A cc ra C ro ss -s ec tio na l q ue st io nn ai re s ur ve y Th e ag e ra ng e of  p ar tic ip an ts w as  4 0 to  8 0  ye ar s, w ith  th e  m aj or ity (5 3. 7% ) fa lli ng b et w ee n  40 a nd  4 9  ye ar s. M os t pa rt ic ip an ts (7 9. 2% ) w er e m ar rie d, 7 7. 5% w er e C hr is tia ns a nd  1 9. 4% M us lim s, an d  th e  re m ai ni ng c am e fro m  o th er re li- gi ou s gr ou ps , a nd  7 1. 1% w er e em pl oy ed . A bo ut a  q ua rt er (2 5. 2% ) h ad a tt ai ne d a  ba ch el or ’s de gr ee o r h ig he r. Th e m aj or ity o f p ar tic ip an ts w er e em pl oy ed (7 1. 1% ), w hi le  1 9. 9% w er e un em pl oy ed an d  5. 3% w er e re tir ed 35 6 H ig h le ve l o f P Ca a w ar en es s (8 6% ), ye t f ew h ad b ee n sc re en ed (2 3% ). H ow ev er , m os t w er e w ill in g to  u nd er go sc re en in g if  re co m m en de d (7 9. 2% ). La ck of  fa m ily h is to ry w ith  P Ca c or re la te d w ith  lo w er s cr ee ni ng ra te s an d  in te nt io ns to  d is cu ss it w ith  a  d oc to r. O ve ra ll kn ow l- ed ge a bo ut  P Ca w as  li m ite d, w ith  m an y m is co nc ep tio ns a bo ut  s ym pt om s an d  ou tc om es . P er ce iv ed s us ce pt ib il- ity to  P Ca w as  lo w a m on g  pa rt ic ip an ts . Th os e w ho h ad b ee n sc re en ed (2 3% ) h ad fe w er p er ce iv ed b ar rie rs to  s cr ee ni ng [7 ] G ha na , S un ya ni M un ic ip al ity C ro ss -s ec tio na l s tu dy M en a ge d be tw ee n  45 a nd  6 0  ye ar s (6 8. 1% ) a nd  id en tifi ed a s  C hr is - tia ns (9 0. 6% ). 87 .5 % w er e m ar rie d an d  th e  m aj or ity h ad a tt ai ne d ed uc at io n at  th e  un iv er si ty le ve l ( 90 .6 % ). Th ey w er e pr ed om in an tly A ka ns (6 5. 6% ) 16 0 Th e m aj or ity a ck no w le dg ed th e  po te nt ia l fa ta lit y of  P Ca (9 3. 8% ) a nd  th e  po s- si bi lit y of  p re ve nt io n th ro ug h  re gu la r sc re en in g (9 6. 9% ). Th er e w er e m is co n- ce pt io ns a bo ut  it s ca us es , w ith  1 3. 1% be lie vi ng it m ig ht b e ca us ed b y  ra di a- tio n fro m  m ob ile p ho ne s. A dd iti on - al ly , s om e re sp on de nt s he ld b el ie fs ab ou t P Ca b ei ng in cu ra bl e (2 .5 % ) al th ou gh  th e  m aj or ity d is ag re ed th at  P Ca is  a ss oc ia te d w ith  c ur se s/ ta bo o (9 8. 1% ). Th e m aj or ity (9 7. 5% ) ag re ed o n  th e  im po rt an ce o f s cr ee n- in g an d  95 .6 % e xp re ss ed w ill in gn es s to  u nd er go s cr ee ni ng if  g iv en  th e op po r- tu ni ty . H ow ev er , c on ce rn s ab ou t p ai n (1 1. 9% ) a nd  e m ba rr as sm en t ( 6. 9% ) w er e ev id en t, al on g  w ith  m is co nc ep tio ns ab ou t s cr ee ni ng a gg ra va tin g th e  di se as e (7 .5 % ) [6 7] Page 7 of 17Ofori et al. African Journal of Urology (2025) 31:41 Ta bl e  1  (c on tin ue d) Co un tr y an d ge og ra ph ic re gi on St ud y de si gn Pa rt ic ip an t c ha ra ct er is tic s Sa m pl e si ze Cu ltu ra l b el ie fs a nd p er ce pt io ns A ut ho r( s) re fe re nc es N ig er ia , t hr ee g eo po lit ic al z on es Q ua lit at iv e in te rp re ta tiv e de sc rip tio n de si gn M en di ag no se d w ith  P Ca , a ge d be tw ee n  54 a nd  8 4  ye ar s, w ith in  th ei r fir st 2  y ea rs a ft er  d ia gn os is . M os t h ad co m pl et ed b as ic e du ca tio n (8 1. 5% ), w ith  s om e re tir ed fr om  c iv il se rv ic e (4 8. 1% ), an d  ot he rs e ng ag ed in  fa rm in g (2 5. 9% ) o r t ra di ng (1 8. 5% ) 27 Th e pa rt ic ip an ts ’ b el ie fs s ur ro un di ng PC a w er e la rg el y ne ga tiv e, w ith  m aj or - ity h ol di ng v ie w s of  it b ei ng a ss oc ia te d w ith  w itc hc ra ft a nd  p ro m is cu ity . D is cu s- si on s ab ou t P Ca w er e of te n di sc ou ra ge d or  k ep t h id de n du e to  s oc ie ta l s tig m a. So m e pe rc ei ve d it as  in cu ra bl e an d  sy n- on ym ou s w ith  d ea th , r efl ec tin g va ry in g de gr ee s of  s tig m a an d  fe ar a ss oc ia te d w ith  th e  di se as e [1 8] So ut he rn N ig er ia , O gu n St at e D es cr ip tiv e cr os s‐ se ct io na l d es ig n H al f o f t he  p ar tic ip an ts (4 9. 7% ) c om - pr is ed y ou ng er a nd  m id dl e- ag ed m en , m os t h av in g co m pl et ed s ec on da ry e du - ca tio n. A bo ut 4 8. 7% w er e se lf- em pl oy ed or  a rt is an s, an d  th e  m aj or ity e ar ne d le ss  th an  N 18 ,0 00 (1 1. 50 U SD ) m on th ly . M os t i de nt ifi ed a s  C hr is tia ns (6 5. 6% ) an d  90 .6 % w er e m ar rie d, w ith  th e  m aj or - ity (6 0. 2% ) h av in g fe w er th an  fo ur ch ild re n 42 2 So ci al fa ct or s su ch a s  ag e, re lig io n, an d  in co m e sh ap ed p er ce pt io ns o f P Ca ris k an d  sc re en in g de ci si on s. M id dl e- ag ed m en p er ce iv ed P Ca a s  a  gr ea te r ris k, w hi le  M us lim s in  ru ra l c om - m un iti es w er e le ss  li ke ly to  p er ce iv e th em se lv es a t r is k. A dd iti on al ly , i nc om e di sp ar iti es n eg at iv el y im pa ct ed P Ca ris k pe rc ep tio n an d  sc re en in g be ha vi or am on gs t t he  s tu dy p op ul at io n [2 ] N ig er ia , B en in C ity Q ua lit at iv e st ud y N ig er ia n m en a ge d be tw ee n  40 an d  60  y ea rs , w ho v is ite d th e  U ro lo gy D ep ar tm en t o f t he  U ni ve rs ity o f B en in Te ac hi ng H os pi ta l f or  P SA te st in g fro m  Ju ly to  A ug us t 2 01 0. T he y w er e al l w el l-e du ca te d in di vi du al s, pr ofi ci en t in  b ot h  sp ok en a nd  w rit te n En gl is h an d  be lo ng ed to  s oc io -e co no m ic ba ck gr ou nd s ra ng in g fro m  a ve ra ge to  a bo ve  a ve ra ge 10 Pa rt ic ip an ts o ft en s ou gh t m ed ic al a dv ic e ba se d on  th e  ex pe rie nc es o f f rie nd s an d  re la tiv es w ith  P Ca . F ea r a ls o  pl ay ed a  ke y ro le , d riv en b y  co nc er ns a bo ut  p er - so na l r is k af te r w itn es si ng th e  im pa ct of  th e  di se as e on  lo ve d on es . B ei ng m ar - rie d or  in  a p ar tn er sh ip w as  a ss oc ia te d w ith  in cr ea se d te st in g up ta ke a nd  o ld er ag e w as  li nk ed to  h ei gh te ne d aw ar en es s of  h ea lth is su es , i nc lu di ng  p ro st at e he al th [1 6] Page 8 of 17Ofori et al. African Journal of Urology (2025) 31:41 Ta bl e  1  (c on tin ue d) Co un tr y an d ge og ra ph ic re gi on St ud y de si gn Pa rt ic ip an t c ha ra ct er is tic s Sa m pl e si ze Cu ltu ra l b el ie fs a nd p er ce pt io ns A ut ho r( s) re fe re nc es Ke ny a, G at un du N or th , a nd  K ia m bu S ub - co un tie s D es cr ip tiv e cr os s- se ct io na l s ur ve y M en a ge d 40 –6 9  ye ar s, pr ed om i- na nt ly fr om  a gr ic ul tu ra l b ac kg ro un ds . Th e m aj or ity w er e C hr is tia ns (9 8. 1% ), an d  m os t w er e m ar rie d (8 1. 4% ), w hi le  5 .9 % w er e si ng le , 6 .9 % d iv or ce d, an d  5. 7% w id ow ed . I n te rm s of  e m pl oy - m en t, 40 .1 % w er e sm al l-s ca le fa rm er s, an d  24 .8 % w er e ca su al w or ke rs . R eg ar d- in g ed uc at io n, 4 6. 4% h ad s ec on da ry ed uc at io n, w hi le  4 1. 3% h ad o nl y  pr im ar y ed uc at io n 57 6 Th e m os t c om m on ly re po rt ed b ar rie r to  P Ca s cr ee ni ng w as  th e  be lie f t ha t t he y w er e he al th y an d  di d no t n ee d it (5 6. 9% ). O th er re as on s in cl ud ed th e  in ab ili ty to  a ffo rd s cr ee ni ng (1 4. 7% ), th e  pe rc ep - tio n th at  s cr ee ni ng is  n ot  b en efi ci al (1 3. 7% ), la ck o f i nf or m at io n (7 .8 % ), an d  co nc er ns th at  s cr ee ni ng is  to o ris ky (6 .9 % ). M is co nc ep tio ns a bo ut  th e  ca us es of  P Ca in cl ud e be lie fs s uc h as  th e  de ni al of  c on ju ga l r ig ht s by  s po us es in  th e  m en - op au sa l s ta ge , t he  n ot io n th at  b ac te ria ca n ca us e th e  di se as e, a nd  th e  id ea th at  m as tu rb at io n in cr ea se s th e  ris k. O th er b el ie fs a ss oc ia te P Ca w ith  h av - in g m ul tip le s ex ua l p ar tn er s or  v ie w in g it as  a  fo rm o f p un is hm en t f ro m  G od . Pa rt ic ip an ts m en tio ne d pr ev en tiv e m ea su re s su ch a s  m ai nt ai ni ng h yg ie ne , co ns um in g tr ad iti on al fo od s, an d  pl ac in g tr us t i n  G od [4 2] Ke ny a, M ak ue ni C ou nt y C ro ss -s ec tio na l q ua nt ita tiv e st ud y M en w ith  a n  av er ag e ag e of  4 9. 8  ye ar s, ra ng in g fro m  2 5 to  9 8  ye ar s. A bo ut o ne - th ird (3 2. 9% ) w er e un de r 4 0  ye ar s. M os t pa rt ic ip an ts (8 5% ) w er e m ar rie d, a nd  9 4% w er e C hr is tia ns . E du ca tio na l l ev el s w er e ge ne ra lly lo w , w ith  2 5% h av in g no  fo rm al ed uc at io n an d  on ly  6 .4 % h av in g te rt ia ry ed uc at io n 15 5 H ig h fa ta lis tic b el ie fs re ga rd in g  PC a an d  sc re en in g (m ea n sc or e: 3 .6 ), co up le d w ith  c on si de ra bl e fe ar o r a pp re he ns io n (m ea n sc or e: 3 .2 ) a bo ut  th e  sc re en - in g pr oc es s. H ow ev er , t he y st ro ng ly en do rs ed th e  pe rc ei ve d be ne fit s of  s cr ee ni ng (m ea n sc or e: 4 .2 ), co ns id - er in g it an  e ffe ct iv e m et ho d fo r e ar ly de te ct io n an d  tr ea tm en t o f P Ca . F am ily in flu en ce (m ea n sc or e: 3 .9 ) p la ye d a  si g- ni fic an t r ol e in  d ec is io n- m ak in g re ga rd - in g  sc re en in g, w ith  a  m aj or ity o f m en (8 9% ) i nd ic at in g th ey w ou ld fo llo w th ei r fa m ily ’s gu id an ce o n  th e  m at te r [4 6] Page 9 of 17Ofori et al. African Journal of Urology (2025) 31:41 Ta bl e  1  (c on tin ue d) Co un tr y an d ge og ra ph ic re gi on St ud y de si gn Pa rt ic ip an t c ha ra ct er is tic s Sa m pl e si ze Cu ltu ra l b el ie fs a nd p er ce pt io ns A ut ho r( s) re fe re nc es U ga nd a, K am pa la D es cr ip tiv e cr os s- se ct io na l s tu dy M al e pa rt ic ip an ts , w ith  th e  m aj or ity id en tif yi ng a s  C hr is tia ns (6 3. 1% ), fo llo w ed by  M us lim s (3 1. 7% ), ad he re nt s of  A fri ca n tr ad iti on al re lig io n (2 .4 % ), or  o th er re lig io us d en om in at io ns (2 .8 % ). M os t re sp on de nt s w er e un m ar rie d (5 7. 1% ) or  m ar rie d (3 7. 6% ), w ith  s m al le r p ro po r- tio ns b ei ng d iv or ce d (2 .6 % ) o r c at eg o- riz ed u nd er  o th er m ar ita l s ta tu se s (2 .7 % ). Th e m aj or ity o f p ar tic ip an ts h ad a tt ai ne d ed uc at io n up  to  th e se co nd ar y le ve l 54 5 So m e co nf us ed P Ca w ith  g on or - rh ea a nd  b el ie ve d it w as  c on ta gi ou s. Fe w (1 0. 3% ) h ad g oo d kn ow le dg e ab ou t s ym pt om s or  s cr ee ni ng m et ho ds . A tt itu de s w er e in flu en ce d by  th e  pe r- ce pt io n th at  P Ca w as  le ss  s er io us th an  H IV . W hi le 1 4. 9% o f p ar tic ip an ts di d no t b el ie ve th ey w er e su sc ep tib le to  P Ca , 2 1. 6% w er e un su re a bo ut  th ei r su sc ep tib ili ty . A dd iti on al ly , m os t p ar tic i- pa nt s be lie ve d th e  di se as e w as  in cu ra bl e, al th ou gh  s om e ac kn ow le dg ed th ei r r is k. A ge w as  a  s ig ni fic an t f ac to r i nfl ue nc in g sc re en in g pr ac tic es [4 8] U ga nd a, K az o di st ric t D es cr ip tiv e cr os s- se ct io na l s tu dy Pa rt ic ip an ts ’ a ge s ra ng ed fr om  4 0 to  8 2  ye ar s ol d. A bo ut 4 4. 3% h ad co m pl et ed p rim ar y sc ho ol e du ca tio n w ith  2 2% h av in g no  fo rm al e du ca - tio n. M os t p ar tic ip an ts w er e m ar rie d (8 8. 7% ), an d  a  su bs ta nt ia l n um be r w er e se lf- em pl oy ed (4 3. 3% ). Th e m aj or ity (5 6. 3% ) r ep or te d m on th ly e ar ni ng s be tw ee n  30 ,0 00 U G X an d  20 0, 00 0 (8 –5 6 U S do lla rs ). Ca th ol ic s (3 4. 3% ) a nd  P ro t- es ta nt s (5 4. 3) w er e th e  m aj or re lig io us de no m in at io ns o f t he  s tu dy p ar tic ip an ts 30 0 D es pi te k no w in g ab ou t P Ca , m os t m en (9 6. 67 % ) h ad n ot  b ee n sc re en ed . Be in g m ar rie d in cr ea se d th e  lik el ih oo d of  s cr ee ni ng . I nf or m at io n ab ou t P Ca m ai nl y ca m e fro m  m ed ia a nd  fr ie nd s ra th er th an  h ea lth ca re p ro vi de rs . H ea lth ca re w or ke rs ’ a tt itu de s an d  pe r- ce iv ed a ffo rd ab ili ty o f s cr ee ni ng te st s al so  in flu en ce d sc re en in g de ci si on s. Th e fe ar o f e m ba rr as sm en t o r i nt ru si on in to  p er so na l l iv es d ue to  th e  vu ln er ab il- ity a ss oc ia te d w ith  th e  D RE w as  a  s ig ni fi- ca nt fa ct or th at  p re ve nt ed p ar tic ip an ts fro m  s ee ki ng s cr ee ni ng s er vi ce s [4 7] So ut hw es t T an za ni a, M be ya C ity C ou nc il C ro ss -s ec tio na l s tu dy M en (1 8 to  7 5  ye ar s) w ith  th e  m os t co m m on a ge g ro up b ei ng 3 8– 47  y ea rs (2 9. 5% ). Th e m aj or ity o f p ar tic ip an ts (7 0. 5% ) w er e m ar rie d, w ith  o nl y  13 .6 % be in g si ng le . A bo ut h al f o f t he  p ar tic i- pa nt s (4 7. 0% ) h ad c om pl et ed s ec on d- ar y sc ho ol , a nd  7 .6 % h ad n o  fo rm al ed uc at io n. In te rm s of  o cc up at io n, 3 6. 4% w er e fa rm er s, 18 .9 % w er e em pl oy ed , an d  15 .2 % w er e un em pl oy ed 13 2 O ut o f a ll pa rt ic ip an ts , 2 2 (1 6. 7% ) s tr on gl y be lie ve d th at  P Ca s cr ee ni ng , p ar tic ul ar ly th e  D RE , c an le ad to  a  lo ss o f d ig ni ty , w hi le  1 8% th ou gh t i t c ou ld c au se s id e eff ec ts o n  th e  bo dy . A dd iti on al ly , 3 4. 1% st ro ng ly d is ag re ed th at  s cr ee ni ng is  a  w as te o ft im e [3 7] Page 10 of 17Ofori et al. African Journal of Urology (2025) 31:41 Ta bl e  1  (c on tin ue d) Co un tr y an d ge og ra ph ic re gi on St ud y de si gn Pa rt ic ip an t c ha ra ct er is tic s Sa m pl e si ze Cu ltu ra l b el ie fs a nd p er ce pt io ns A ut ho r( s) re fe re nc es Zi m ba bw e, K ad om a D is tr ic t Q ua nt ita tiv e an d  qu al ita tiv e re se ar ch m et ho ds 68 % o f t he  re sp on de nt s w er e un de r 4 0  ye ar s ol d. A do le sc en ts m ad e up  2 9% o f t he  p ar tic ip an ts . 5 5% of  re sp on de nt s w er e m ar rie d or  c oh ab - iti ng , a nd  3 9% h ad n ev er m ar rie d. A  s m al l p ro po rt io n w er e ei th er  w id ow ed or  d iv or ce d, e ac h ac co un tin g fo r 3 % . T he sa m pl e w as  h ig hl y ed uc at ed , w ith  7 0% ha vi ng c om pl et ed s ec on da ry s ch oo l an d  17 % c om pl et in g pr im ar y ed uc at io n 50 0 Th e st ud y fo un d th at  m os t c om m un ity m em be rs w er e un aw ar e of  P Ca , w ith  fe w kn ow in g ab ou t i t. So m e be lie ve P Ca m os tly a ffe ct s se xu al ly a ct iv e m en in  th ei r re pr od uc tiv e ye ar s. O nl y 11 % k ne w th at  m en o ve r 5 0 sh ou ld b e sc re en ed , an d  no ne o f t he  re sp on de nt s ag ed 6 0 to  7 9 w er e aw ar e th ey n ee de d sc re en - in g, d es pi te  b ei ng a t h ig he r r is k. M os t re sp on de nt s (7 8% ) g ot th ei r i nf or m at io n fro m  fr ie nd s, w hi ch m ay e xp la in th es e be lie fs [4 5] Ca m er oo n, B am en da Q ua lit at iv e re se ar ch s tu dy Th e av er ag e ag e of  p ar tic ip an ts w as  5 9. 2  ye ar s. Si xt y pe rc en t d id no t c om pl et e hi gh s ch oo l, an d  48 % w er e em pl oy ed . T he m aj or ity (9 2% ) id en tifi ed a s  C hr is tia n, a nd  m os t w er e m ar rie d (8 0% ). A dd iti on al ly , 6 0% e ar ne d le ss  th an  5 0, 00 0 fra nc s (8 3 U SD ) m on th ly . N ot ab ly , 8 4% re po rt ed th at  th ey h ad ne ve r b ee n ad vi se d by  a  h ea lth ca re pr ov id er to  g et s cr ee ne d fo r P Ca 35 Pa rt ic ip an ts m os tly re lie d on  tr ad iti on al m ed ic in e in iti al ly fo r P Ca , d riv en b y  cu l- tu ra l b el ie fs a nd  n or m s. La ck o f a w ar e- ne ss a bo ut  th e  di se as e an d  its s cr ee n- in g m et ho ds c on tr ib ut ed to  d el ay ed di ag no si s. Fe ar , s tig m a, a nd  e co no m ic co ns tr ai nt s al so  in flu en ce d at tit ud es an d  be ha vi or s, le ad in g to  s el f-m ed ic at io n an d  ba rr ie rs to  s ee ki ng ti m el y ca re [2 6] Page 11 of 17Ofori et al. African Journal of Urology (2025) 31:41 participants were farmers and casual workers who per- ceived PCa as linked to sexual activity [42, 48]. Five studies found that some men avoided PCa test- ing and care due to the perception of fatalism, believ- ing that if they were destined to get the disease, they would, regardless of screening or treatment while some men even considered themselves immune due to their masculinity, viewing those susceptible to PCa as being ‘less manly’ [6, 42, 46, 48, 65]. Fatalistic attitudes were particularly strong in communities with lower access to formal education, such as Makueni County in Kenya, where high fatalistic beliefs were recorded [46]. In the Ashanti region of Ghana, where all participants were market women and about 81% had never attended school, there was a common belief that nothing could be done to save a prostate cancer patient [65]. In con- trast, low fatalistic beliefs were observed in the Free State province of South Africa, where most participants had at least a secondary school education and a family history of cancer, which may have influenced their per- ception of PCa [6]. Three studies noted the significant role of perceived benefits of screening and family influence in encouraging men to seek PCa care [6, 65, 67]. Four studies reported concerns about social stigma, particularly the fear that seeking PCa screening could reveal private health matters or sexual health status [6, 22, 26, 47]. In Kazo District, Uganda where education level was seen to be low among the study participants, there was limited knowledge and widespread misconcep- tions about PCa [47]. This lack of understanding height- ened fear and stigma, leading some men to believe that undergoing screening would result in social rejection or discrimination. Also, the negative perception of cancer further reinforced their reluctance, as they associated a PCa diagnosis with a potential health decline, intensify- ing their fear of societal judgment [47]. In Mhondoro- Ngezi, Zimbabwe, the fear and stigma surrounding PCa screening stemmed from deep-rooted associations between prostate cancer, masculinity, and sexual health [26]. The study participants believed that a PCa diagnosis implied sexual weakness or loss of virility, causing reluc- tance to openly discuss or seek medical attention for the disease [26]. Additionally, some men feared that the testing process would be physically uncomfortable [37, 46], These mis- conceptions were largely shaped by their belief that the DRE is a painful procedure, a perception influenced by health misinformation and a lack of understanding about the test’s actual procedure. Others associated PCa with older age, leading them to believe they were not at risk [18, 45, 48, 67]. This miscon- ception was driven by limited exposure to information about PCa, which reinforced the belief that it is a disease affecting only older men. Religious beliefs also played a role, with some men believing that they could rely on a supreme being for help, others relating the disease to some unforeseen supernatural forces [2, 26, 49, 65]. In South Africa, over 80% of men from the Zion Christian Church believed that prayer alone could protect them from PCa, which reduced their likelihood of seeking medical screening [49]. In Nigeria, religious affiliation influenced risk per- ception, with Muslim participants being less likely to acknowledge their susceptibility to PCa, leading to lower screening rates [2]. For participants in Mhondoro-Ngezi, Zimbabwe, friends and social circles were the primary sources of PCa-related knowledge, which may have contributed to the spread of misconceptions and misinformation, rein- forcing religious and supernatural explanations of the disease [26]. Interestingly, among participants in Kumasi, Ghana, only a few individuals associated PCa with a spir- itual cause, even though the majority identified as Chris- tians, suggesting that religious affiliation alone may not always determine PCa-related beliefs [65]. Some men related their susceptibility to PCa to their ancestry or family history of the disease [6, 7, 18, 65]. Men in Ghana and Nigeria who had a family history of PCa were more likely to recognize their own risk, yet many still avoided screening due to fear of diagnosis [7, 18]. Lastly, in a few cases, a group of men did not see any need for seeking PCa screening, considering it as a waste of time [2, 6, 18, 48]. This was particularly true among men from rural areas with limited healthcare access, where PCa screening was seen as unnecessary unless symptoms were severe. 3.5 � Traditional medicine practices for prostate cancer care Traditional medicinal plants have been relied on heav- ily in many parts of SSA over the years for the treatment of several health conditions, including PCa, due to a strong cultural preference for these over Western medi- cine [31, 40, 55]. In this section, we summarize studies that have explored the anti-cancer effects of these plants on PCa cell lines in vitro. These studies (Supplementary Table  1) suggest that certain traditional plants used in SSA contain active compounds with possible anti-cancer properties. Given the cultural context in the SSA region, the data obtained from this review suggests that with further research, traditional medicines could play a comple- mentary role in PCa management after proper diagno- sis. However, it is important to emphasize that because some herbal medicines can have side effects, there should be medical supervision before use. Currently, some men Page 12 of 17Ofori et al. African Journal of Urology (2025) 31:41 in the region start taking these medicines without a con- firmed diagnosis, either believing they are not at risk of PCa or thinking that continuous use of these medicines offers protection against the disease [2, 6, 18, 48]. This behavior poses a significant public health concern as cer- tain herbal formulations may be toxic and could lead to adverse effects, including liver damage. 3.6 � Recommended programs for promoting prostate cancer awareness and early detection Strong cultural beliefs among men in SSA, along with limited access to healthcare, continue to hinder the early detection of PCa. There is a pressing need for compre- hensive awareness and early detection programs across all countries in the region. These programs must be sup- ported by strong political commitments to raise aware- ness among men about the importance of PCa screening and care. The goals of these programs should be to edu- cate men about prostate health, dispel myths and stigmas surrounding the disease, and encourage regular screen- ing. This section summarizes several recommended pro- grams from the reviewed studies that are designed to boost PCa awareness and promote early detection in the SSA region. 3.6.1 � Community engagement and education Several studies in this review identified community- based interventions as effective in improving PCa aware- ness and early detection in SSA. These interventions focus on increasing the scientific knowledge of key com- munity stakeholders, such as traditional leaders and faith-based organizations, enabling them to promote screening and early detection within their communities effectively [18]. One study emphasized the importance of involving men in planning cancer prevention and con- trol programs, given that PCa primarily affects men [42]. Educational interventions that empower men with accu- rate information about PCa have been recommended to increase screening uptake [37, 42]. Targeting health cam- paigns and sensitization programs for men with lower levels of education, who are at higher risk of late-stage diagnosis, may also be beneficial [48]. Additionally, addressing cultural beliefs and soci- etal expectations of gender expectations is particularly important, as these factors often lead men to downplay their health concerns [17]. A study by [56] suggests that considering men’s emotional states during educational processes may be important, given their tendency to be stoic due to cultural norms. The majority of the studies reported that educational levels influence men’s health- seeking behavior, with men who receive pre-operative counseling before PCa surgeries better managing pain expectations and post-procedure recovery [22]. Younger men often do not perceive themselves to be at risk for PCa, highlighting the need for age-specific intervention programs [37]. However, knowledge alone may be insuffi- cient to improve health-seeking behavior; attitudes must also be addressed [37]. Studies by [5] and  [45] advocate for aggressive educational campaigns, while another study [26] recommend contextually based health educa- tion tailored to fill the knowledge gaps and address men’s perceptions of PCa. 3.6.2 � Media and outreach initiatives The reviewed studies suggest that media campaigns can be effective in raising PCa awareness in SSA. Television, radio, and social media platforms have played a role in helping shape public knowledge about PCa. However, awareness levels in SSA remain relatively low, and most individuals who had heard about PCa cited mass media as their primary source of information. One study rec- ommended integrating PCa screening advertisements into routine medical examination promotions [67]. Spon- soring radio and TV stations to air PCa-related enlight- enment programs may help expand outreach efforts [18]. Furthermore, health promotion could be achieved through various mass media platforms, including short message service (SMS), posters, and flyers, which provide extensive information about PCa to encourage screening behaviors [2, 67]. Because knowledge about PCa has been linked to screening behavior, one study recommended that out- reach programs assess the knowledge levels of target populations and include recommendations from doc- tors, as medical professionals are generally trusted more than common media advertisements [7]. Some studies also suggest that unmarried men and widowers are less likely to undergo screening compared to married men, who often opt for screening due to personal reasons or spousal recommendations hence, PCa campaign mes- sages should target these groups as it may help increase their willingness to participate in screening [47]. Media awareness programs should highlight the ben- efits of PCa screening and provide information about specific health centers where screening is available [5]. Additionally, to overcome language barriers, advertise- ments and outreach initiatives should be presented in languages that are easily understood by the target popu- lation with the choice of media platforms being based on their accessibility and relevance to the target population to ensure effective dissemination of information [57]. 3.6.3 � Prostate cancer healthcare training for educators and healthcare providers Healthcare providers should be trained on to develop patient-centered care approaches that considers the Page 13 of 17Ofori et al. African Journal of Urology (2025) 31:41 psychological and religious concerns of PCa survivors [49]. Medical professionals should also be encouraged to recommend PCa screening in a more approachable man- ner and stay updated on global PCa screening guidelines [42]. Healthcare workers should also focus on sensitizing and educating partners to continue this encouragement [6, 16, 47, 50]. In terms of educators, two studies conducted in Ghana found that teachers had a relatively high level of aware- ness and knowledge about PCa, which increased their willingness to screen for the disease [5, 67]. Similarly, high levels of PCa awareness were observed among male university students in Ghana and staff in Nigeria, sug- gesting that education level may influence knowledge and screening behavior [5]. 3.6.4 � Accessible screening services The review identified critical barriers to PCa screen- ing, particularly in rural areas, including the distance to screening facilities and the lack of cancer health educa- tion. Ensuring that screening centers are accessible and not congested may improve participation [18]. One study in Ghana found that the cost of diagnosing non- metastatic PCa was $290.58, while metastatic PCa cost $1185.09, highlighting financial constraints as a signifi- cant barrier to care [64]. Therefore, as a result, studies recommend creating free and affordable testing cent- ers and providing cost-effective treatment options for those affected [16, 19]. Imaging centers should also be made easily accessible as it may help increase screening behaviors [47]. Some studies also suggest that assessing the knowledge of screening methods in a population is assessed through the use of different forms of screening methods as it may help to better understand which meth- ods people are aware of [37]. Also, PCa screening ser- vices should be extended to rural areas, and government agencies in charge of PCa management should focus on where patients live as this could help address both the supply and demand sides simultaneously [61]. One study also suggested that researchers partnering with governments and local authorities to conduct whole genome sequencing studies for high-risk PCa in men could help account for ethnic and environmental differ- ences and also potentially help choose the best screen- ing methods for specific populations [23]. There should be aggressive screening for symptomatic men, and those with non-modifiable risk factors should be routinely screened [6, 19]. Additionally, screening men who pre- sent with lower urinary tract infections may also help detect PCa early, as these infections may be an early sign of PCa [6]. Efforts should focus on reaching men who have never been screened before and addressing the mindset about masculinity that deters them from screening [17]. Since there are differences in the effectiveness of various tests (PSA, DRE, and imaging), more studies are needed in dif- ferent settings to evaluate what works best for them [68]. 3.6.5 � Use of culturally relevant tools A pilot study has highlighted the development of an Akan PCa awareness tool in Ghana, specifically designed to assess knowledge, awareness, and perception among Ghanaians [65]. This tool, validated and piloted for its high reliability, was found to be effective in communicat- ing information about PCa to the local community using the Akan language [65]. Tailored to the linguistic and cul- tural context of the Akan-speaking population, the tool ensures relevance and effectiveness, making it a promis- ing model for adoption and expansion to other countries in SSA. It was suggested that this tool be expanded to different local languages to increase PCa awareness and ensure effective communication across diverse cultural settings. Additionally, recommendations have been made for using the theory of planned behavior in various SSA con- texts to address the diverse cultural aspects of participant populations [46]. Culturally sensitive methods could also be employed to target asymptomatic men with localized tumors, as it could reduce mortality [67]. Furthermore, the health belief model (HBM) has been recommended to help individuals make behavior changes based on their perceptions of the severity and susceptibility to PCa, the benefits of behavioural change, and the barriers to such changes [16]. 3.7 � Discussion This systematic review provides an overview of the cur- rent state of PCa in SSA and how it is influenced by various cultural factors. With projections from GLOBO- CAN indicating that the cases of PCa in SSA will dou- ble by 2040, addressing this urgent public health concern requires comprehensive strategies aimed at reducing PCa incidence in the region. Our analysis of 34 studies across diverse SSA countries, including South Africa, Ghana, Nigeria, Uganda, Tanzania, Burkina Faso, Cameroon, Kenya, and Zimbabwe, reveals the complex interplay between cultural beliefs and PCa care. The significant impact of cultural beliefs on when men seek PCa care is evident. Fatalism and masculinity are major barriers, with most men believing that if they are destined to get PCa, they will get it regardless of their actions [6, 41, 42, 48, 65]. This finding aligns with studies on Black men in the U.S. and Europe, where fatalism and constructs of masculinity similarly hinder PCa screening [12, 27]. The social stigma associated with PCa also deters men from seeking screening, fearing that their health status Page 14 of 17Ofori et al. African Journal of Urology (2025) 31:41 will be publicly known [6, 12, 22, 26, 47]. This stigma is consistent with findings from studies on Black and Latino men in Philadelphia and men in Newfoundland and Lab- rador [10, 60]. Religious beliefs and the association of PCa with older age further complicate timely screening [2, 18, 26, 45, 48, 49, 65, 67]. Religious beliefs can both hinder and empower men regarding PCa treatment, as seen in African American communities [38]. Age-related beliefs, combined with varying recommendations on screening ages across different organizations, necessitate clearer guidelines and awareness campaigns in SSA [11, 28, 63]. Educational level and urban versus rural residence sig- nificantly influence PCa awareness and screening atti- tudes. Men with higher education and those in urban areas were more informed and proactive about screening, while men with lower educational levels and men from rural backgrounds were linked to limited knowledge and negative perceptions. This pattern is supported by stud- ies on African American men [14]. Encouraging educated individuals to disseminate PCa knowledge within their communities can help raise awareness. Positive influ- ences, such as family support and perceived benefits of screening, play an important role in encouraging men to seek PCa care. To better understand the barriers to prostate cancer PCa care in SSA, sociological perspectives such as the HBM and Social Determinants of Health (SDH) can pro- vide an additional layer of information and understand- ing into the perceptions identified in this study. The HBM includes four key factors; perceived susceptibility, per- ceived severity, perceived barriers, and perceived benefits influences an individual’s willingness to seek PCa care [24, 29]. In Ghana, this model was used to examine PCa screening behaviors, but its predictive power was lim- ited, suggesting that public awareness about PCa remains low [65]. In Egypt, an educational intervention based on the HBM was introduced to assess PCa knowledge and beliefs among men. By comparing survey results before, immediately after, and months after the intervention, researchers found that perceptions and knowledge about PCa had improved significantly [29]. A similar study in Iran among military personnel showed that within three months of an HBM-based educational program, their awareness, perceived risk, benefits, and self-efficacy related to PCa screening had improved considerably [1]. These findings suggest that HBM-based educational pro- grams in SSA could play a vital role in changing percep- tions and increasing awareness about PCa. Additionally, social determinants of health (SDH) such as socioeconomic status, education level, health- care access, and living conditions are known to strongly influence PCa risks and outcomes [13]. The disparities in these factors across SSA contributed to the perceptions identified in this review. Addressing these challenges requires targeted interventions that consider the social and environmental context of PCa patients. Expanding outreach to remote areas, improving healthcare acces- sibility, and increasing public education efforts are criti- cal steps in reducing PCa disparities in SSA. Our review identifies major interventions to improve PCa percep- tions in SSA, including community-based programs, engagement with traditional leaders and faith-based organizations, and media campaigns. A study in Greater Boston and Cambridge showed that church-based inter- ventions could enhance informed decision-making regarding PCa care [15]. Integrating traditional medicine with modern healthcare and using culturally relevant tools can increase community participation in screening and treatment programs. Training healthcare providers to address patients’ psychological and religious needs, alongside advocating for regular screening, is essential for improving PCa management in the region. The major interventions identified in this review must be sustained and evaluated to assess their long-term impact on PCa awareness and screening programs in SSA. This would require community involvement, pol- icy integration, and funding support. Community-based interventions can be sustained by training civil society organizations (CSOs), traditional leaders, and faith-based groups to lead PCa education and outreach efforts [58, 59]. Embedding PCa awareness into existing national cancer programs and securing consistent government and NGO funding will help maintain these efforts. PCa awareness should be integrated into public health pro- grams, schools, and workplaces. Schools can include PCa topics in health curricula, while employers can promote screening through workplace wellness programs. Public health campaigns should also incorporate PCa education alongside existing disease prevention efforts like HIV screening. In SSA, most rural areas lack access to health centers, and those with some available are community clinics [30]. Nonetheless, these community clinics should be equipped and leveraged to improve screening services in these areas and governments should adopt policies for free or subsidized screening and incorporate screen- ing into national health insurance plans. There should be government-backed policies to ensure free or subsidized screening in healthcare centers and encourage the use of mobile screening units to reach underserved populations. Also, since these healthcare systems are responsible for providing the health needs of people seeking prostate cancer care, they should be equipped with affordable and effective PCa screening tools to expand access, especially in rural areas. Healthcare providers should also offer cul- turally sensitive counseling to address fears, stigma, and Page 15 of 17Ofori et al. African Journal of Urology (2025) 31:41 misinformation about screening. The interventions they put in place should be tailored to patient needs and they should ensure that the needs of patients are met. Strengthening community health providers (CHPs) through formal training and financial incentives can ensure continued patient education and follow-up sup- port. CHPs should also be provided with continuous training as this could position them with knowledge on PCa care and help them develop patient-centered coun- seling services to address stigma and misinformation. A review assessing the impact of communication skills training (CST) for CHPs found that CST likely helps CHPs develop empathy and improves some aspects of their communication with patients [44]. Addition- ally, understanding the unique communication needs of patients allows healthcare professionals to design better interventions to support cancer patients. Another study highlighted that a key role of CHPs is to ensure that patients, families, and individuals coming for routine screening receive clear and accurate information [32]. Feeling heard and well-informed can encourage indi- viduals to seek care and follow through with screening. Therefore, training CHPs in effective communication is essential to ensure they provide the right support, guid- ance, and reassurance to those at risk of PCa. Lastly, media campaigns should be expanded through SMS, radio, and TV ads, with messages adapted to local languages to maximize outreach and these campaigns should adopt a culturally sensitive approach to avoid dis- crimination. Government, through their national health authorities must lead these efforts to ensure consistent public engagement beyond short-term projects. These programs must also be evaluated to ensure that they are effective and lead to impactful outcomes and as such evaluation metrics should be incorporated to track pro- gress and effectiveness. For the purposes of PCa aware- ness key performance indicators could include tracking the increase in PCa screening rates over time in com- munities where interventions are implemented. Also, monthly and yearly surveys could be conducted to assess changes in PCa awareness, risk perception, and under- standing of screening benefits. The number of events held, attendance rates and engagement levels in outreach programs led by CSOs and health workers should also be measured. 3.8 � Strengths and limitations The findings presented in this review can help guide tar- geted interventions to improve awareness, screening, and treatment in the region. A key strength of this review is the systematic approach used in identifying and analyz- ing studies, ensuring a comprehensive assessment of cultural perspectives on PCa in SSA. However, despite a robust search strategy, the number of studies retrieved was limited, which may not fully capture the diversity of cultural beliefs and healthcare experiences across all SSA countries. As a result, the findings may not provide a complete picture of PCa-related cultural perceptions in the region. More research involving diverse populations and broader geographic coverage is needed to strengthen understanding and inform more effective interventions. 4 � Conclusion This review highlights the urgent need to address cul- tural barriers and enhance healthcare access to improve PCa outcomes in SSA. An understanding of the cultural, socio-demographic, and systemic barriers to PCa care in SSA is necessary for developing effective strategies to enhance early detection and treatment. Comprehensive and culturally sensitive interventions, combined with education and community engagement, can significantly improve PCa outcomes in SSA. Supplementary Information The online version contains supplementary material available at https://​doi.​ org/​10.​1186/​s12301-​025-​00512-y. Additional file 1. Additional file 2. Author contribution Conceptualization, BO and KF; writing-original draft, BO and KF; writing-review and editing, ARA and KANS. All authors have read and agreed to the published version of the manuscript. Funding No external funding was received for the research, authorship, or publication of this paper. Data availability No datasets were generated or analysed during the current study. Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Received: 3 October 2024 Accepted: 11 June 2025 References 1. 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Afr J Urol 24:45–53. https://​doi.​org/​10.​1016/j.​afju.​ 2017.​09.​004 Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in pub- lished maps and institutional affiliations. https://doi.org/10.1002/14651858.CD003751.pub4 https://doi.org/10.1002/14651858.CD003751.pub4 https://doi.org/10.1111/ecc.12493 https://doi.org/10.1186/s12889-017-4897-0 https://doi.org/10.1186/s12889-017-4897-0 https://doi.org/10.1155/2023/7770943 https://doi.org/10.1155/2023/7770943 https://doi.org/10.1016/j.afju.2013.08.001 https://doi.org/10.1007/s10943-021-01406-3 https://doi.org/10.1007/s10943-021-01406-3 https://doi.org/10.1186/s12301-023-00372-4 https://doi.org/10.1200/GO.20.00294 https://doi.org/10.1186/s12939-023-01962-y https://doi.org/10.1136/bmj.n71 https://doi.org/10.1101/cshperspect.a030361 https://doi.org/10.1101/cshperspect.a030361 https://doi.org/10.4314/ahs.v21i4.31 https://doi.org/10.4314/ahs.v21i4.31 https://doi.org/10.1177/26323524231176829 https://doi.org/10.1177/26323524231176829 https://doi.org/10.1007/s40487-020-00125-1 https://doi.org/10.1007/s40487-020-00125-1 https://doi.org/10.1097/JU.0000000000003931 https://doi.org/10.1186/s12889-021-10793-x https://doi.org/10.1186/s12889-021-10793-x https://doi.org/10.1177/1073274819886930 https://doi.org/10.1093/jncics/pkab093 https://doi.org/10.1016/j.urology.2017.08.012 https://doi.org/10.1186/s12913-022-08476-3 https://doi.org/10.1186/s12913-022-08476-3 https://doi.org/10.1371/journal.pone.0267797 https://doi.org/10.1002/pros.24360 https://doi.org/10.1016/j.afju.2016.12.003 https://doi.org/10.1016/j.afju.2016.12.003 https://doi.org/10.1016/j.afju.2017.09.004 https://doi.org/10.1016/j.afju.2017.09.004 The intersection of culture and prostate cancer care in Sub-Saharan Africa: a systematic review Abstract Background Method Results Conclusion 1 Background 2 Methodology 2.1 2.1 Inclusion criteria 2.2 2.2 Exclusion criteria 2.3 2.3 Quality assessment 2.4 2.4 Data extraction 3 Results 3.1 Overview 3.2 Educational background of screened men 3.3 Prevalence and incidence rates 3.4 Cultural beliefs and attitudes towards prostate cancer screening in Sub-Saharan Africa 3.5 Traditional medicine practices for prostate cancer care 3.6 Recommended programs for promoting prostate cancer awareness and early detection 3.6.1 Community engagement and education 3.6.2 Media and outreach initiatives 3.6.3 Prostate cancer healthcare training for educators and healthcare providers 3.6.4 Accessible screening services 3.6.5 Use of culturally relevant tools 3.7 Discussion 3.8 Strengths and limitations 4 Conclusion References