Prostate cancer epidemiology across malaria-endemic settings in SSA: a systematic review and meta-analysis

Abstract

The incidence of Prostate cancer in sub-Saharan Africa (SSA) has increased over the past decade. The presence of other enabling factors, such as late-stage diagnosis, aggressive disease, and constrained treatment access, contributes to poor outcomes in the region. This study synthesises epidemiological evidence on prostate cancer in SSA while comparing incidence and mortality patterns across malaria-endemic countries within the region. This study used the PRISMA 2020 guidelines and systematically reviewed studies from various databases and included studies based on preset inclusion criteria. Five databases (PubMed/MEDLINE, Embase, Scopus, Web of Science, and African Journals Online) were searched and screened with a backward citation screening. Studies included are published works reporting incidence, temporal trends, grade or stage at diagnosis, and survival or mortality among SSA men. After a rigorous selection process, thirty-one studies met the eligibility criteria. These selected studies spanned 15 countries in addition to a multicountry registry, which covered 12 SSA regions. Eight studies (22 observations) contributed ASR/ASIR data; median ASRs ranged from 6.3 per 100,000 in a non-endemic rural registry to 58.5 per 100,000 in a seasonal endemic setting, with high-endemic areas showing a median of 50.8 per 100,000 and no statistically significant differences across endemicity categories. A random-effects meta-analysis of five studies ( n = 1,395) estimated that 45% of men presented with high-grade disease, with substantial between-study heterogeneity. Population-based registries reported five-year observed survival (39%) and relative survival (60%), while facility-based cohorts reported markedly lower survival (11% at 36 months in an Ethiopian cohort). In conclusion, the study highlights a significant burden and aggressiveness of prostate cancer within the region. However, no consistent incidence gradient by malaria endemicity was highlighted. There is a need for strengthening of cancer registries across the region to ensure surveillance and reporting to clarify malaria–cancer interactions.