As September marks Prostate Cancer Awareness Month, South Africa faces a quiet, deadly crisis: the disease is now the most common cancer among local men, yet awareness remains dangerously low.
Despite 1 in 4 black South African men facing a diagnosis in their lifetime, thousands only seek help when the disease is already far advanced.
Local specialists warn that breaking the silence and expanding early screening is a matter of life and death.
According to GLOBOCAN, the specialised cancer research agency of the World Health Organization (WHO), prostate cancer has officially surpassed all other types of cancer to rank as the most prevalent form of cancer among men in South Africa.
It also stands as the second most lethal cancer in men locally, surpassed only by lung cancer.
Despite these alarming statistics, a profound knowledge deficit persists.
A 2023 study conducted among black men diagnosed with prostate cancer in the Free State revealed that fewer than one in four (22%) had ever heard of prostate cancer before their diagnosis.
Another study published the same year among men in Limpopo found that nearly two-thirds had inadequate awareness of the disease, while more than 80% possessed no knowledge of screening methods whatsoever.
This lack of awareness presents an urgent public health threat, given the baseline risk South African men carry.
Lifetime statistics reveal that one in eight white men and one in four black men in South Africa will be diagnosed with prostate cancer. Black African men face a 60% higher risk of developing the disease than white men and are 2.5 times more likely to die from it.
Unravelling the genetic link and healthcare disparities
According to Andrew Oberholzer, chief executive officer of the Prostate Cancer Foundation of South Africa, the disparity runs deeper than socio-economic factors alone.
"Black African men are even more prone to develop prostate cancer. Studies are seeking to identify the genetic factors that could help explain this increased risk.
"We don't know what the specific genome is at this point, but there is a lot of research going into trying to identify the actual genes responsible. It is essentially an underlying genetic factor that puts them more at risk," Oberholzer explains.
Inherited genetic factors account for up to 57% of a man's overall susceptibility to developing prostate cancer. Because of this elevated genetic risk, national clinical guidelines established by the Prostate Cancer Foundation recommend that high-risk men begin routine annual screening from age 40.
High-risk individuals include men of black African ancestry, anyone with a first-degree relative history of prostate or breast cancer, and individuals with a known BRCA2 gene mutation. For men with average risk, routine screening is recommended starting at age 45.
Yet, guidelines mean little when systemic barriers prevent men from accessing routine care.
A 2026 study conducted by researchers at Walter Sisulu University confirmed that late presentation remains a widespread challenge across South Africa, highlighting severe gaps in early detection, delayed referral pathways and limited local access to Prostate-Specific Antigen (PSA) testing.
"In rural hospitals where there are no urologists, there are no biopsies being done," says Oberholzer.
"Those patients often have to travel long distances to a tertiary hospital. Furthermore, primary healthcare clinics have historically prioritised women's and children's health. Clinics are not particularly men-friendly and often turn men away who want to be screened, telling them to come back when they have symptoms.
"That is the worst thing you can do, because there are no symptoms in the early stages of prostate cancer, and the early stage is the only time we can cure this disease."
Overcoming stigma, fear and advanced stage complications
When prostate cancer is detected early and treated while confined to the gland, the five-year survival rate exceeds 98% to 99%. However, once the cancer metastasises to distant sites, that five-year survival rate plummets to just 30%.
Because early-stage prostate cancer develops silently without noticeable warning signs, waiting for symptoms to appear frequently means waiting until the disease is incurable. Symptoms of advanced prostate cancer include:
Difficulty urinating or weakened flow.
Blood in the urine or semen.
Unexplained erectile dysfunction.
Persistent bone pain, fatigue or weight loss.
Weakness or numbness in the legs and feet.
Oberholzer highlights that cultural stigmas around masculinity compound the problem, causing men to hide symptoms until catastrophic complications arise.
"Prostate cancer spreads into the bones, and if it reaches the spinal vertebrae, it can cause a compression fracture and paralysis," Oberholzer warns.
"We actually have men coming into clinics when they already have lower-leg weakness or full paralysis because they've waited so long and ignored all the symptoms. That attitude of 'men shouldn’t show weakness' directly perpetuates the problem."
Furthermore, fear surrounding the diagnostic process and treatment side effects keeps many men away from clinics. Oberholzer clarifies that diagnostic protocols have evolved to be far less invasive.
"The fear was primarily based on the fact that we used to recommend screening with a digital rectal exam (DRE) alongside a PSA blood test. In our latest guidelines, we recommend just the PSA blood test for men who are not experiencing symptoms.
"PSA is a simple protein check; it isn't a cancer-specific test, but it tells us if something is wrong with the prostate so we can refer the patient to a urologist."
When advanced disease is diagnosed, treatment relies heavily on Androgen Deprivation Therapy (ADT) to strip testosterone from the body to slow tumour growth. This carries side effects like erectile dysfunction, loss of muscle mass and fatigue.
In rural public healthcare settings where advanced hormone-blocking medications may be unavailable, surgical castration is sometimes the only option offered, a prospect that drives many men to abandon care altogether.
Mobilising support
To fight this systemic crisis, the Prostate Cancer Foundation has partnered with the non-profit data analysis organisation Health Quality Assessment (HQA) and various medical societies to build South Africa's first comprehensive Prostate Cancer Registry.
This initiative aims to bridge the critical gap in accurate national epidemiological data to better direct healthcare funding and public resources.
Simultaneously, grassroots campaigns are working to shift public perception and fund subsidised testing.
Partnering with the Cancer Association of South Africa (CANSA), initiatives like the Prostate Cancer Foundation’s Suit Up September and the upcoming Hollard Daredevil Run, taking place on Friday, October 23, raise vital funds to deploy mobile PSA screening into under-resourced communities.
"Low awareness, limited access to screening, and the life-saving potential of early detection are at the heart of the Hollard Daredevil Run," says Adél Kriel, head of experiential marketing at Hollard South Africa.
"Too many South African men still know too little about prostate cancer, their personal risk, and the importance of getting screened. We need to keep changing that conversation," Kriel says.
Beyond public events, Oberholzer emphasises that women often hold the key to saving men's lives.
"Wherever possible, we talk to women as well. Women are much more proactive when it comes to going for health checks. We encourage women to remind their partners to go for overall check-ups and PSA tests.
"My advice to every man over 40 is simple: don't wait for symptoms. You might feel healthy and fit, but screening and early detection are how we save lives."
alyssia.birjalal@nationalmg.co.za