Prostate cancer screening and associated factors in Ethiopia: a systematic review and meta-analysis

Abstract

BACKGROUND: Prostate cancer is a leading cause of cancer-related morbidity and mortality among men worldwide. Despite its growing burden, screening uptake remains low in many low- and middle-income countries, including Ethiopia. Early detection through screening is essential, yet awareness and access remain limited. METHODS: This systematic review and meta-analysis followed PRISMA guidelines. We searched PubMed, Scopus, Web of Science, AJOL, and Google Scholar for studies published 30 August 2025 using terms related to prostate cancer, screening, and Ethiopia. Observational studies of prostate cancer screening were included. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. Pooled prevalence was estimated with a random-effects meta-analysis; heterogeneity and publication bias were evaluated using I² and funnel plots with Egger's test. Significant factors were summarized narratively. RESULTS: Twelve studies, including 7526 participants from Addis Ababa, Southern, Central, and Amhara regions, were analyzed. The pooled prevalence of prostate cancer screening was 30.37% (95% CI: 20.49-40.25% I² = 96.7%, p < 0.001). Subgroup analysis showed the highest prevalence in the Wolaita Sodo (63.08%, 95% CI: 58.73-69.22%), followed by Amhara region (47.97%( 95% CI: 42.02-53.92), and the lowest in central Ethiopia region (7.19%, 95% CI: 4.75-9.67%). Significantly associated factors included awareness of prostate cancer screening (AOR = 3.36, 95% CI: 1.87-6.85), age of the patients > 45 years (AOR = 3.53, 95% CI: 1.69-5.46), regular checkup of cancer (AOR = 3.65, 95% CI: 1.09-6.20), average income ≥ 5000 ETB (AOR = 3.80, 95% CI: 2.28-5.31), family history of prostate cancer (AOR = 3.87,95% CI: 2.30-5.45), and ever heard about prostate cancer (AOR = 3.15,95% CI: 1.43-4.88). CONCLUSION: Prostate cancer screening in Ethiopia remains low, with marked regional differences. Uptake is higher among older men, those with higher income, prior awareness, family history, or regular health checkups. Targeted educational programs and improved access to screening are urgently needed. Nationwide, longitudinal, and mixed-method studies are essential to evaluate interventions and understand behavioral, cultural, and systemic factors affecting screening practices. CONCLUSION: Prostate cancer screening in Ethiopia remains low, with marked regional differences. Uptake is higher among older men, those with higher income, prior awareness, family history, or regular health checkups. Targeted educational programs and improved access to screening are urgently needed. Nationwide, longitudinal, and mixed-method studies are essential to evaluate interventions and understand behavioral, cultural, and systemic factors affecting screening practices.