Prostate Cancer diagnosis and management: current practices in Africa a consultant-based survey AUTHORS AND AFFILIATION LIST

Biyouma Marcella Derboise Christelle ^1,2* Kaleab Habtemichael Gebreselassie ^2,3 Nedjin Abdelkerim Saleh ^2,4 Ouima Justin Dieudonné Ziba ^2,5 Nwaha Makon Axel Stephane ^1,6 Anteneh Tadesse Kifle ^2,7 Ngwa‐Ebogo Tagang Titus ⁸ Taofiq Olayinka Mohammed ⁹ Ayun K Cassell III ¹⁰ Bencherki Youssef ^11,2 Sissoko Idrissa ¹² Orgeness Jasper Mbwambo ^13,2 Mahamat Ali Mahamat ¹⁴ Rachid Raboutaieb ¹⁵ Ndoye Alain Khassim ^16,17 Olapade- Olaopa Emiola Oluwabunmi ¹⁸ Fru Fobuzshi Angwafo III ⁶

• ¹ Service d'Urologie, Département de Chirurgie, Hôpital laquintinie de Douala, Douala, Cameroon
• ² Modern Urology For Africa (MUFA), Casablanca, Morocco
• ³ Urology Unit, Worabe Comprehensive Specialized Hospital, Worabe, Ethiopia
• ⁴ Service de Chirurgie, Hôpital Universitaire La Renaissance,, Ndjamena, Chad
• ⁵ Service d'Urologie et Andrologie, Département de Chirurgie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
• ⁶ Département de Chirurgie et sous-spécialités, Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroon
• ⁷ Department of Surgery,P.C.E.A Chogoria Hospital, Chogoria, Kenya
• ⁸ Department of Clinical Sciences, Faculty of Health Sciences, The University of Bamenda, Bambili, Northwest Region, Cameroon
• ⁹ Division of Urology,Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara State,, Nigeria
• ¹⁰ Department of Surgery, John F Kennedy Medical Centre, Monrovia, Liberia
• ¹¹ Service d'Urologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
• ¹² Service de Chirurgie, Centre Hospitalier Universitaire de Kati, Kati, Mali
• ¹³ Department of Urology, Kilimanjaro Christian Medical College, Moshi, Tanzania
• ¹⁴ Faculté des Sciences de la Santé Humaine, Université de Ndjamena, Ndjamena, Chad
• ¹⁵ Faculté de Médecine et de Pharmacie, Université Hassan II de Casablanca, Casablanca, Morocco
• ¹⁶ Département de Chirurgie et Spécialités Chirurgicales. Faculté de Médecine, de Pharmacie et d’Ondo-stomatologie, Université Cheikh Anta Diop,, Dakar, Senegal
• ¹⁷ Service d'Urologie et Andrologie, Hôpital Aristide Le Dantec,, Dakar, Senegal
• ¹⁸ Department of Surgery, Urology Division, College of Medicine,University of Ibadan and University College Hospital, Ibadan, Nigeria, Ibadan, Oyo State, Nigeria

In Africa, prostate cancer poses significant diagnostic and treatment challenges due to limited access to diagnostic tools and healthcare resources. This survey aimed to assess current prostate biopsy practices, patient classification methods, and available therapeutic means among African urologists to propose strategies for improved screening, diagnosis, and management.A web-based self-administered questionnaire was distributed to urologists in 58 African centres, focusing on biopsy practices, cancer diagnosis, management, and treatment protocols.After pretesting and validation, data collection spanned six weeks, followed by duplicate elimination and arithmetical analysis, with results expressed in absolute, mean, or percentage values.Feedback was received from 58 centres across diverse African regions, including Central, Southern, West, East Africa, and Madagascar, comprising general, private, and university hospitals. Prostate cancer emerged as the most frequent urological cancer in all regions studied.The assay for prostate-specific antigen (PSA) was available in nearly all centres. Biopsy techniques varied, with ultrasound-guided biopsies being the most common (30 centres), followed by digital-guided (20 centres) and MRI-guided biopsies (5 centres). One centre lacked the expertise to perform biopsies. Radiological workup availability was high, with CT available in 56 centres, MRI in 54, PET scans in 14, and scintigraphy in 29. Treatment capabilities varied, with 53.4% of centres able to perform radical prostatectomies, 86.2% offering radiotherapy, and 94.8% providing medical castration. Among the centres, 56 performed fewer than 5 radical prostatectomies per month, while only 2 centres performed between 5 and 10 per month.It is important to standardize prostate cancer diagnosis and treatment protocols across Africa while improving access to advanced diagnostic technologies and treatment facilities.Implementing these changes could enhance early detection, improve treatment outcomes, and reduce the burden of prostate cancer in Africa.