Conclusion
The development of guidelines and recommendations for PSA screening has been challenging. The authors have had to strike a balance and make recommendations applicable to both a well-resourced private sector and an under-resourced public sector. Epidemiological data showing the burden of disease, especially the rates of advanced disease in the coloured and black SA populations, [3,4,37-40] suggest
The development of guidelines and recommendations for PSA screening has been challenging. The authors have had to strike a balance and make recommendations applicable to both a well-resourced private sector and an under-resourced public sector. Epidemiological data showing the burden of disease, especially the rates of advanced disease in the coloured and black SA populations,[3,4,37-40] suggest that a national PCa screening programme will be worthwhile; however, multiple factors make the roll-out of such a campaign particularly complex.
Various studies have reported on the barriers to PCa screening in Africa, which include lack of patient education, poor uptake in low socioeconomic communities, and lack of resources to implement screening as well as treatment.[2,41] The logistical and resource-related challenges to roll out an effective screening programme would be immense but not insurmountable. Achieving good uptake and participation in such a programme, especially in the black South African male population, will require an in-depth understanding of cultural and gender-specific beliefs within the different communities, especially in rural areas, where these ideas are even more entrenched.[2,39]
The dearth of urological services to treat increased numbers of PCa patients, especially in the public sector,[42,43] leaves us with ethical questions regarding the initiation of a more robust screening programme. The inevitable increased burden of disease may, on the other hand, place greater focus on the severely under-resourced men’s health sector in our country. Although implementing a national screening programme is not yet a reality, these guidelines aim to encourage general practitioners and primary care physicians to implement screening for the correct patients in the correct way, within the resources available.
South African Urology Association and the Prostate Cancer Foundation of South Africa: The South African Prostate Cancer Screening Guidelines (SAMJ_CME)_May 2024, Vol. 114, No. 5