Factors associated with late diagnosis of prostate cancer in Togo, Sub-Saharan Africa

Factors associated with late diagnosis of prostate cancer in Togo, Sub-Saharan Africa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors associated with late diagnosis of prostate cancer in Togo, Sub-Saharan Africa Tchin Darré, Toukilnan Djiwa, Essodina Padja, Panakinao Simgban, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4699979/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Prostate cancer represents a real public health issue in countries with limited resources and is often diagnosed at late stages. The aim of the study was to determine the factors associated with late diagnosis of prostate cancer in Togo. Methods : This was a cross-sectional study with a descriptive and analytical, relating to cases of prostate cancer, diagnosed in the Urology department and histologically confirmed at the Pathological Anatomy and Cytology Laboratory of the Lomé; from April 4, 2022 to April 28, 2023, in Togo. Results : A total, 102 cases of prostate cancer were recorded. The average age was 67.79 ± 8.5 years. The mean PSA level was 521.3933±1060 ng/ml. Histologically, it was acinar adenocarcinoma in 99.02%. All patients in our study were diagnosed at the late stage with 31.37% pT3NxMx stage and 68.63% pT4NxMx stage of the pTNM classification. It was Gleason score 9 in 31 patients (30.39%). After multivariate analysis, two factors were associated with late diagnosis of prostate cancer : diagnostic error (p-value = 0.032; ORC = 1.30; 95% CI [1.10-24.9]); taking a second opinion (p-value = 0.0170; ORa = 2.62; 95% CI [2.01-4.7]). However, factors involving easy access to the health system before prostate cancer diagnosis appear to be major protective factors for diagnosis at an advanced stage of disease. Conclusion : The diagnosis error and the taking of a second opinion are the factors on which it will be necessary to act to make an early diagnosis of prostate cancer in our context. prostate cancer late diagnosis associated factors Togo. Background Prostate cancer is a malignant tumor proliferation developed at the expense of the normal constituents of the prostate or at the expense of an organ, secondarily invading the prostate [ 1 ]. It is adenocarcinoma in more than 90% of cases; squamous cell carcinoma and neuroendocrine carcinoma being very rare [ 2 – 4 ]. In 2020, prostate cancer was the fourth most diagnosed cancer in the world, and was responsible for 375,304 cancer deaths, or 3.8% of all cancer deaths [ 5 ]. In Africa, prostate cancer ranks third among all cancers after breast (16.8%) and cervical cancer [ 5 ]. In West Africa, the incidence of prostate cancer was 26,392 cases in 2020 with 14,903 deaths [ 5 ]. In developing countries, prostate cancer is still most often discovered at locally advanced or metastatic stages [ 6 ]. This late diagnosis is often explained by a late consultation, the ignorance of the population, the distance from reference centers, marked poverty, the absence of systematic screening, and by the existence of prejudices and false beliefs about pathology [ 3 , 7 , 8 ]. In Togo, prostate cancer is discovered in 75.9% of cases at metastatic stages, a stage where treatment is limited and very expensive in our country [ 9 ]. Also, the data on this pathology are only epidemiological and histopathological. We thus initiated this study whose general objective was to determine the factors associated with the late diagnosis of prostate cancer in our Togolese context. Methods This was a cross-sectional study with a descriptive and analytical aim focusing on cases of prostate cancer, followed in the Urology department and confirmed histologically in the Pathological Anatomy and Cytology laboratory of the University Hospital Center Sylvanus Olympio from April 4, 2022 to April 28, 2023; a period of 12 months. Included in our study were all cases of prostate cancer followed in the urology department, and histologically confirmed in the Pathological Anatomy and Cytology laboratory, during our study period and who verbally consented to participate in the study. Cases of prostate tumors not histologically confirmed or for which informed consent was not obtained were not included. The variables studied included sociodemographic and economic characteristics (age, profession, marital status, level of education, membership in health insurance, consultation with a urologist, prostate cancer screening test, fears of diagnostic procedures, fear of having a cancer diagnosis, lack of financial means, distance from reference health structures); the history of the diagnosis of prostate cancer (consultation time, symptoms, profile of the first contact caregiver, socio-cultural habits, diagnosis during the first consultation, treatment during the first consultation, need for a second notice); patients' knowledge of prostate cancer (general apprehension, method of information, family history of prostate cancer, knowledge of the progression of prostate cancer, knowledge of the possibility of screening for prostate cancer, knowledge of therapeutic possibilities, adherence to patient treatment); biochemical data based on PSA (Prostate Specific Antigen) level; histopathological data (histological type, histoprognostic grade and pTNM stage). The data were analyzed with R software version 4.0.4. A logistic regression made it possible to correlate the factors associated with diagnostic delay with a significance threshold set at 0.05. Results Epidemiological data Table 1 summarizes the socio-demographic characteristics of the patients. We collected 102 cases of prostate cancer. The average age of our patients was 67.79 ± 8.5 years with extremes of 50 and 86 years. Twenty-five patients (25) were aged between 65–70 years, representing 24.5% of all cases (Table I). Ninety-three percent (93.13%) of the patients were married. Sixty-seven percent (67.7%) of our respondents were in school and 32.3% were not in school (Table I). It was a retiree in 49 cases (48.04%). A percentage of 20.4 patients had heard of prostate cancer, four patients had already been screened for prostate cancer. Ninety-eight patients (98) or 96.1% had never been screened, the main reason being the lack of information. A family history of prostate cancer was noted in 18 patients or 17.7%. The family members concerned were the brother in 7 cases, the uncle in 6 cases and the father in 3 cases. Table 1 : Summary of patients' socio-demographic characteristics Number (N=102) Percentage Age (Years) 70 14 13.72 Level of education No education 33 32.35 Primary education 24 23.54 Secondary education 35 34.31 University level 10 9.8 Profession Retired 49 48.04 Retailer 35 34.31 Civil servant 18 17.65 Marital status Married 95 93.13 Widowed 6 5.88 Divorced 1 0.99 Table 2 : Comparative analysis of factors associated with late diagnosis of prostate cancer Diagnostic delay < 12 months (67) n(%) ≥12 months (35) n(%) Total (102) n(%) P-value No screening 0.00045 Yes 64(95.52) 34(97.14) 98(96.07) No 3(4.48) 1(2.86) 4(3.92) Lack of financial resources 0.396 Yes 40(60.61) 13(37.14) 54(52.9) No 26(39.39) 22(62.96) 48(47.05) Health insurance Yes No 49(73.13) 18(26.86) 31(88.57) 4(11.43) 80(78.4) 22(21.56) 0.1127 Misdiagnosis 0.0170 Table 3 : Univariate and multivariate analysis of sociodemographic factors involved in late diagnosis of prostate cancer Long diagnostic delay Univariate analysis Multivariate analysis n/N % RO CI95% P-value ROa CI95% P-value Level of education No education Enrolled in school 33 32.35 69 67.64 1 1.504 0.6-3.6 0.36 Distance between care facilities and home 20 Km 40 39.22 37 36.27 25 24.51 0.81 0.27-2 0.711 0.89 0.34-2.3 0.82 1 Health insurance Yes No 22 21.57 80 78.43 0.29 0.08-1.0 0.065 1 0.54 0.113-2.58 0.441 Fear of cancer diagnosis Yes No 37 36.27 65 63.72 1.59 0.64-3.9 0.317 1 Lack of financial resources Yes No 48 47.06 54 52.94 0.44 0.18-1.03 0.06 1 0.58 0.2-1.706 0.323 Distance from the referral centre Yes No 25 24.75 77 75.25 0.56 0.219-1.45 0.23 1 Lack of information Yes No 34 32.67 68 67.33 1 0.75 0.30-1.8 0.543 Table 4 : Univariate and multivariate analysis of knowledge factors involved in the late diagnosis of prostate cancer Long diagnostic delay Univariate analysis Multivariate analysis n/N % RO CI 95% P-value ROa CI95% P-value No screening Yes No 98 96.08 4 3.92 1 0.76 0.75-7.5 0.812 Already heard of prostate cancer Yes No 41 40.19 61 59.80 0.52 0.31-1.8 0.522 1 Family history of prostate cancer Yes No 18 17.64 84 82.35 1.18 0.39-3.49 0.765 1 Table 5 : Univariate and multivariate analysis of clinical factors involved in the late diagnosis of prostate cancer Long diagnostic delay Univariate analysis Multivariate analysis n/N % RO CI 95% P-value ROa CI95% P-value Type of staff Medical staff Traditional healer 81 21 1 0.23 0.08-0.628 0.004 0.392 0.12-1.25 0.114 Misdiagnosis Yes No 49 53 0.25 0.10-0.63 0.003 1 1.30 1.10-4.9 0.032 Second opinion Yes No 26 76 2.57 1.01-6.514 0.046 1 3.26 1.06-10.1 0.04 Data related to late diagnosis of prostate cancer The average time for medical consultation was 20.73 ± 10.17 months with extremes of 4 and 50 months. It was 3.26 ± 3.46 months with extremes of 20 days and 240 months or 2 years. This delay was 10.39 ± 15.05 months with extremes of 1.64 and 114 months or 10.21 years. From the first signs, 57.8% of patients had consulted the doctor while 14.7% of patients had already opted respectively for traditional therapy and 4.9% had sought the advice of a loved one. Among the reasons for consultation, 95 patients presented urinary frequency. There were respectively 64 cases, 47 cases, 45 cases and 41 cases of dysuria, burning when urinating, urine retention and bone pain. Forty-five (45) patients presented with an alteration in their general condition, 33 patients complained of paresthesia and 12 patients had hemospermia. We observed 9 cases and 7 cases respectively of paraparesis and hematuria. All participants with a confirmed histological diagnosis of prostate cancer were all diagnosed at the late stage with 31.37% PT3NxMx stage and 68.63% PT4NxMx stage of the pTNM classification. Acinar adenocarcinoma was found in 99% of cases and squamous cell carcinoma in 1% of cases. In our study, the mean value of the PSA level before any treatment was 521.39 ± 1060 ng/ml with extremes of 11ng/ml and 6140 ng/ml. Sixty-seven percent (67%) patients had a PSA level greater than 100 ng/ml. Regarding the histoprognostic grade, 30.4% of patients had a Gleason score of 9. Factors associated with late diagnosis of Prostate Cancer with statistical analyzes After comparative analysis, two factors were associated with late diagnosis, namely: the absence of screening for prostate cancer with a p-value of 0.00045, the diagnostic error during the first consultations with a p-value of 0.0170 (Table II). Multivariate analysis of sociodemographic factors revealed that none of these factors was associated with late diagnosis of prostate cancer (Table III). Multivariate analysis of prostate cancer knowledge factors revealed that none was associated with late diagnosis of prostate cancer (Table IV). Multivariate analysis of clinical factors revealed that two of them were associated with late diagnosis of prostate cancer. The first was the diagnostic error (p-value = 0.032; OR = 1.30; 95% CI [1.10–4.9]), the second was the taking of a second opinion (p-value = 0 .04; OR = 3.26; 95% CI [1.06–10.1] (Table V). Discussion Epidemiological data We identified 102 cases of prostate cancer in a single year. Tengue et al. in 2014 found an annual frequency of 77.3 cases [ 9 ]. This demonstrates a clear increase in the incidence of prostate cancer in Togo. The average age of our patients was 67.79 ± 8.5 years with age ranges of 50 and 86 years. The age range [65; 70[ years was the most represented with a percentage of 24.5. Similar age averages were reported by Tengue et al. (68.5 years), as well as Mbey et al. (68.7 years) [ 9 , 10 ]. Indeed, prostate cancer remains the prerogative of the elderly according to the literature [ 1 , 8 , 11 ]. A family history of prostate cancer was noted in 17.7% of patients. Darré et al. found a family history of prostate cancer in 41.38% [ 12 ]. Data related to late diagnosis of prostate cancer Functional urinary signs were the most frequently recorded revealing signs with 95 cases of pollakiuria and 6 4 cases of dysuria. These results are similar to those of Tengue et al. who described symptoms of the lower urinary tract in 89.2% [ 9 ]. Darré et al. had also found functional urinary signs in 37.93% [ 12 ]. This high frequency of functional urinary disorders could be explained by the fact that they constitute a nuisance in daily life forcing the patient to consult. Bone pain and deterioration of general condition were found in 41 cases and 47 cases respectively. Tengue et al. also found an alteration of the general condition respectively in 82.3% [ 9 ]. Overall, the existence of functional manifestations during prostate cancer disease would reflect an advanced stage of this pathology [ 13 ]. The TNM classification was specified in all our respondents, which allowed us to establish the classification into stages. The entire series consisted only of advanced cases, classified stage PT3NxMx (31.37%) and pT4NxMx (68.63%). These results are similar to those reported by Tengue et al. which found 75.9% of metastasized tumors [ 9 ]. Likewise Sine et al. found 96.5% of advanced cancers [ 14 ]. The current trend shows that approximately 15% of patients with prostate cancer are diagnosed at an advanced stage [ 15 ]. Histologically, these were adenocarcinomas in 99% and squamous cell carcinoma in 1%. These were only adenocarcinomas in the series by Darré et al. [ 12 ]. A predominance of prostate adenocarcinomas was also reported by Ndoye et al. in 97.7% of cases [ 16 ]. According to the literature, prostate adenocarcinoma represents more than 90% of cases of prostate cancer; squamous cell carcinoma and neuroendocrine carcinoma being very rare [ 2 , 3 ]. The Gleason score was specified in all patients. In our study, ISUP grade 5 corresponding to Gleason score 9 was the most represented with 30.39%. Bouanika et al. as well as boulfhrad et al. also reported a predominance of score 9 [ 17 , 18 ]. The average PSA level at the time of diagnosis was 521.39 ng/ml with extremes of 11 and 6140.5 ng/ml). Omisanjo et al. found a similar mean PSA of 563.2ng/ml [ 19 ]. Niang et al. as well as Sine et al. found a mean PSA value before any treatment of 1447.57 ng/ml and 1367 ng/ml respectively [ 14 , 20 ]. Screening for prostate cancer in the presence of elevated serum PSA levels has been used in men aged over 50 years since at least 1992 [ 21 ]. Indeed, screening based on prostate specific antigen (PSA) is one of the most common methods of diagnosing prostate cancer. However PSA expression has also been reported in other tissues such as normal prostate epithelium, small intestine, kidney cells and salivary organs, but the expression level in these parts is 100 to 1000 times lower than that of prostate cancer [ 22 ]. In 2018, the U.S. Preventive Services Task Force suggested that for all men aged 70 and older, prostate cancer screening based on a PSA blood test be suspended; for men aged 55 to 69, individual screening based on an informed discussion with the doctor and no screening for men under 55 [ 23 , 24 ]. In routine practice, guidelines are often not followed and one of the main reasons for this is the lack of knowledge of the recommendations among primary care general practitioners [ 25 , 26 ]. These generally high PSA levels in our context could be explained by an often late diagnosis. In our series, only 36.3% of patients had to travel a distance of more than 20 km compared to 67.7% who had traveled distances between 0 and 20 km as part of a consultation in a health structure. These results show us that patients living far away consulted less. Also Amborggi et al. reported that the burden of travel between a patient's residence and health centers was an important problem that could influence the early diagnosis and choice of cancer treatment [ 27 ]. Thomas et al. demonstrated that travel burden (measured as travel distance or time) can lead to diagnostic delays and can influence treatment choice for a variety of common cancers [ 28 ]. In the series by Kaboré et al. patients with poor geographic access or living in rural areas (18.3%) were twice as likely to have advanced stages of cancer than urban residents (9.6%) [ 29 ]. Only 3.92% of our respondents were aware of screening and the means of screening for prostate cancer. This result is much lower than that reported by Kaboré et al. which was 29.7% [ 29 ]. In the series by Darré et al. 51.43% of participants had no knowledge of the PSA blood test, with a statistically significant correlation between this knowledge of the PSA blood test with the level of study and the effectiveness of an internship in a health service. urology [ 30 ]. In our study we had difficulty determining the precise consultation period because patients cannot remember exactly the duration before their first consultations. Nevertheless, we used the medical records of these patients. The average consultation time in our series was 20.73 ± 10.17 months. The majority of patients (53.9%) consulted within less than 21 months compared to 46.1% who consulted beyond 21 months. This could be explained on the one hand by the fact that in our society we consider that urinary problems are normal with age; on the other hand, by the lack of knowledge of the signs of the pathology, illiteracy, the preeminence of traditional therapy and by the poverty of the population, the vast majority of which is rural or unemployed in our country. Factors such as poverty, religion, culture, communication barriers, language and costs are thought to affect men's participation in prostate cancer screening [ 31 ]. Factors associated with late diagnosis of Prostate Cancer with statistical analyzes After univariate analysis, five factors were associated with the long diagnosis delay, namely the absence of health insurance, lack of financial means, type of first consultation, diagnostic error and taking a second opinion. Multivariate analysis of all these parameters reveals that two factors were associated with late diagnosis of prostate cancer. The first factor was diagnostic error (with a p-value = 0.032; ORa = 1.30; 95% CI [1.10–4.9]). Thus, for a patient whose initial diagnosis was other than prostate cancer, there would be a 30% higher risk of late diagnosis. This may be explained by insufficient knowledge of the signs and symptoms of prostate cancer by healthcare providers, especially at the primary level. The second factor was the taking of a second opinion (with p-value = 0.04; OR = 3.26; 95% CI [1.06–10.1]; which means that a patient whose initial diagnosis required a second opinion, would have a 3.26 higher risk of late diagnosis. This second opinion may be linked on the one hand to a lack of information and awareness and on the other hand to the strong cultural tendency of population towards traditional therapy. The existence of health insurance would promote early diagnosis [ 31 – 33 ]. Kabore et al. reported the lack of screening program and the insufficiency of the technical platform as associated with the late diagnosis of prostate cancer in our African context [ 29 ]. Limitations The study was carried out among patients followed for prostate cancer in the urology department of the Sylvanus Olympio University Hospital Center (CHU) in Lomé; which limits its representativeness to other patients outside this center or in different care contexts. The results cannot be generalized to all patients with prostate cancer in Togo. The convenience sampling method used in the study may introduce selection bias because participants were chosen based on their availability and access to health care. The data was collected using a questionnaire developed on the basis of a literature review and translated into different languages for a better understanding of the respondents, which may introduce information bias. Participants' responses may be influenced by comprehension errors linked to approximate translations of the questions or by a desire to provide socially acceptable answers. Conclusion Prostate cancer is a current problem in Togo, often diagnosed at a late stage. A total of two factors have been identified as associated with this late diagnosis of prostate cancer; in this case the diagnostic error which can be explained by insufficient knowledge of the signs and symptoms of the pathology by healthcare providers especially at the primary level and the insufficiency of the technical platform; as well as getting a second opinion. It would be wise to assess and upgrade healthcare providers' knowledge of new diagnostic techniques for prostate cancer. Abbreviations ISUP International Society of Urological Pathology OR Adjusted Odds Ratio PSA Antigen Specific of Prostate TNM Tumor Node Metastasis Declarations Ethics approval and consent to participate This study was approved by the “Comité de Bioéthique pour la Recherche en Santé (CBRS)” (Bioethics Committee for Health Research) from the Togo Ministry of Health, Ref N0: 0101/2016/MS/CAB/DGS/DPLET/CBRS).All patients and relatives of patients had received information on the purpose and procedures of this study and provided written and informed consent. The study has been carried out in accordance with relevant guidelines and regulations. Consent for publication Not applicable Availability of data and materials Extracted data are with the corresponding author and available under reasonable request Competing interest The authors declare that they have no competing interests Funding None Acknowledgements Not applicable Authors Contributions T. D was responsible for the conception of the study; participated in the study design; undertook the field study; conducted the data collection, analysis, and interpretation; and wrote the manuscript T.Dj., E.P., P.S.,B.S., M.B., and E.S. were involved in the data collection, analysis, and interpretation. They wrote and finalized the manuscript. G.N.K. is responsible for the overall scientific management of the study, for analysis and interpretation, and for the preparation of the final manuscript. All authors have read and approved the final manuscript for submission for publication. References Schatten H. Brief Overview of Prostate Cancer Statistics, Grading, Diagnosis and Treatment Strategies. Adv Exp Med Biol. 2018;1095:1‑14. Wasim S, Lee SY, Kim J. Complexities of Prostate Cancer. Int J Mol Sci. 2022;23(22):14257. Darré T, Folligan K, Kpatcha TM, Kanassoua K, Sewa E, Daré S, et al. Evolution of the Histo-Epidemiological Profile of Urological Cancers in Togo. 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Darré T, Djiwa T, Kpatcha TM, Sidibé A, Sewa E, Botcho G, et al. Prostate cancer screening: A survey of medical students’ knowledge in Lome, Togo, and associated determinants in a resource-limited African context. SAGE Open Med. 2021;9:20503121211032812. Mumuni S, O’Donnell C, Doody O. The Risk Factors and Screening Uptake for Prostate Cancer: A Scoping Review. Healthc Basel Switz. 2023;11(20):2780. Singh K, Abdel Goad EH, Ramklass SS. Waiting times for prostate cancer diagnosis in KwaZulu-Natal, South Africa. South Afr Med J Suid-Afr Tydskr Vir Geneeskd. 2015;105(6):484‑6. Osowiecka K, Nawrocki S, Kurowicki M, Rucinska M. The Waiting Time of Prostate Cancer Patients in Poland. Int J Environ Res Public Health. 2019;16(3):342. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4699979","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":324544104,"identity":"3860493d-3cac-49d5-b4ad-039cb4e3e322","order_by":0,"name":"Tchin Darré","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYHACxgMMbCCa+QADYwOEJgigWtgSIFqANLFaeAyI02LOfvjAgQ9ldvnm7T3fJH7usJFjYON9gFeLZU9awsEZ55It55w5u02y90yaMQMbuwFeLQYHcgwO87YxG0hI5G6T4G07nNgg34bfYQbn34C01BtIyL95JvkXpIWNjYCWG2BbDgNt4WGT5iVGi+WMZyC/HDeQ4EkztpZtSzNmI6TFnD/54IMPZdUGEuyHH95822Yjx0/QYUhsFgkQSUADqhbmD4RUj4JRMApGwcgEAHLdQ2OIRI6OAAAAAElFTkSuQmCC","orcid":"","institution":"University Teaching Hospital of Lomé","correspondingAuthor":true,"prefix":"","firstName":"Tchin","middleName":"","lastName":"Darré","suffix":""},{"id":324544105,"identity":"757473d5-0a0e-4580-814d-3a7b46224dda","order_by":1,"name":"Toukilnan Djiwa","email":"","orcid":"","institution":"University Teaching Hospital of Lomé","correspondingAuthor":false,"prefix":"","firstName":"Toukilnan","middleName":"","lastName":"Djiwa","suffix":""},{"id":324544106,"identity":"1a2309e2-6884-4d67-9071-951e983ba2f6","order_by":2,"name":"Essodina Padja","email":"","orcid":"","institution":"University Teaching Hospital of Lomé","correspondingAuthor":false,"prefix":"","firstName":"Essodina","middleName":"","lastName":"Padja","suffix":""},{"id":324544107,"identity":"72779bdc-4bf5-4272-8b1b-a64b7653f1c9","order_by":3,"name":"Panakinao Simgban","email":"","orcid":"","institution":"University Teaching Hospital of Lomé","correspondingAuthor":false,"prefix":"","firstName":"Panakinao","middleName":"","lastName":"Simgban","suffix":""},{"id":324544108,"identity":"bf2566b1-e18a-49d6-aa39-8e4aabf4e064","order_by":4,"name":"Bagassam Sama","email":"","orcid":"","institution":"University Teaching Hospital of Lomé","correspondingAuthor":false,"prefix":"","firstName":"Bagassam","middleName":"","lastName":"Sama","suffix":""},{"id":324544109,"identity":"56534e79-25ca-4c06-b676-abc47fa9d467","order_by":5,"name":"Mayi Bombone","email":"","orcid":"","institution":"University Teaching Hospital of Lomé","correspondingAuthor":false,"prefix":"","firstName":"Mayi","middleName":"","lastName":"Bombone","suffix":""},{"id":324544110,"identity":"73a6efd3-4143-4dff-9ca6-780519482f32","order_by":6,"name":"Edoé Sewa","email":"","orcid":"","institution":"University Teaching Hospital of Lomé","correspondingAuthor":false,"prefix":"","firstName":"Edoé","middleName":"","lastName":"Sewa","suffix":""},{"id":324544111,"identity":"b1597e30-9495-4ab5-9c71-44dd52957755","order_by":7,"name":"Gado Napo-Koura","email":"","orcid":"","institution":"University Teaching Hospital of Lomé","correspondingAuthor":false,"prefix":"","firstName":"Gado","middleName":"","lastName":"Napo-Koura","suffix":""}],"badges":[],"createdAt":"2024-07-07 11:26:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4699979/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4699979/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":110059161,"identity":"7223bb2b-933e-45d6-9807-ec93965d357b","added_by":"auto","created_at":"2026-05-27 06:26:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":274719,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4699979/v1/ea1aa93e-9f8a-46f6-8a88-5ef8fb1f076f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors associated with late diagnosis of prostate cancer in Togo, Sub-Saharan Africa","fulltext":[{"header":"Background","content":"\u003cp\u003eProstate cancer is a malignant tumor proliferation developed at the expense of the normal constituents of the prostate or at the expense of an organ, secondarily invading the prostate [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is adenocarcinoma in more than 90% of cases; squamous cell carcinoma and neuroendocrine carcinoma being very rare [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In 2020, prostate cancer was the fourth most diagnosed cancer in the world, and was responsible for 375,304 cancer deaths, or 3.8% of all cancer deaths [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Africa, prostate cancer ranks third among all cancers after breast (16.8%) and cervical cancer [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In West Africa, the incidence of prostate cancer was 26,392 cases in 2020 with 14,903 deaths [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In developing countries, prostate cancer is still most often discovered at locally advanced or metastatic stages [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This late diagnosis is often explained by a late consultation, the ignorance of the population, the distance from reference centers, marked poverty, the absence of systematic screening, and by the existence of prejudices and false beliefs about pathology [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Togo, prostate cancer is discovered in 75.9% of cases at metastatic stages, a stage where treatment is limited and very expensive in our country [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Also, the data on this pathology are only epidemiological and histopathological. We thus initiated this study whose general objective was to determine the factors associated with the late diagnosis of prostate cancer in our Togolese context.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e This was a cross-sectional study with a descriptive and analytical aim focusing on cases of prostate cancer, followed in the Urology department and confirmed histologically in the Pathological Anatomy and Cytology laboratory of the University Hospital Center Sylvanus Olympio from April 4, 2022 to April 28, 2023; a period of 12 months. Included in our study were all cases of prostate cancer followed in the urology department, and histologically confirmed in the Pathological Anatomy and Cytology laboratory, during our study period and who verbally consented to participate in the study. Cases of prostate tumors not histologically confirmed or for which informed consent was not obtained were not included. The variables studied included sociodemographic and economic characteristics (age, profession, marital status, level of education, membership in health insurance, consultation with a urologist, prostate cancer screening test, fears of diagnostic procedures, fear of having a cancer diagnosis, lack of financial means, distance from reference health structures); the history of the diagnosis of prostate cancer (consultation time, symptoms, profile of the first contact caregiver, socio-cultural habits, diagnosis during the first consultation, treatment during the first consultation, need for a second notice); patients' knowledge of prostate cancer (general apprehension, method of information, family history of prostate cancer, knowledge of the progression of prostate cancer, knowledge of the possibility of screening for prostate cancer, knowledge of therapeutic possibilities, adherence to patient treatment); biochemical data based on PSA (Prostate Specific Antigen) level; histopathological data (histological type, histoprognostic grade and pTNM stage). The data were analyzed with R software version 4.0.4. A logistic regression made it possible to correlate the factors associated with diagnostic delay with a significance threshold set at 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eEpidemiological data\u003c/h2\u003e\n \u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the socio-demographic characteristics of the patients. We collected 102 cases of prostate cancer. The average age of our patients was 67.79\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5 years with extremes of 50 and 86 years. Twenty-five patients (25) were aged between 65\u0026ndash;70 years, representing 24.5% of all cases (Table I). Ninety-three percent (93.13%) of the patients were married. Sixty-seven percent (67.7%) of our respondents were in school and 32.3% were not in school (Table I). It was a retiree in 49 cases (48.04%). A percentage of 20.4 patients had heard of prostate cancer, four patients had already been screened for prostate cancer. Ninety-eight patients (98) or 96.1% had never been screened, the main reason being the lack of information. A family history of prostate cancer was noted in 18 patients or 17.7%. The family members concerned were the brother in 7 cases, the uncle in 6 cases and the father in 3 cases.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 1\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;: Summary of patients\u0026apos; socio-demographic characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (N=102)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (Years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;50\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e11.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003e[50- 55[\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003e[55- 60[\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003e[60- 65[\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e18.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003e[65- 70[\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e24.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003e\u0026gt;\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;70\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e13.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e32.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e23.54\u003c/p\u003e\n \u003c/td\u003e\n 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\u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCivil servant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\"\u003e\n \u003cp\u003e17.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarried\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e93.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWidowed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e5.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDivorced\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 2\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e: Comparative analysis of factors associated with late diagnosis of prostate cancer\u003c/strong\u003e\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"689\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.627906976744185%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.30232558139535%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnostic delay\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.86046511627907%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.209302325581396%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.574746008708274%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.44847605224964%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 12 months\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(67) n(%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.949201741654571%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;12 months\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(35) n(%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.835994194484762%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(102) n(%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.191582002902758%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.574746008708274%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo screening\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.44847605224964%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.949201741654571%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.835994194484762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.191582002902758%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.00045\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.574746008708274%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.44847605224964%\" valign=\"top\"\u003e\n \u003cp\u003e64(95.52)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.949201741654571%\" valign=\"top\"\u003e\n \u003cp\u003e34(97.14)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.835994194484762%\" valign=\"top\"\u003e\n \u003cp\u003e98(96.07)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.191582002902758%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.574746008708274%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; No\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.44847605224964%\" valign=\"top\"\u003e\n \u003cp\u003e3(4.48)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.949201741654571%\" valign=\"top\"\u003e\n \u003cp\u003e1(2.86)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.835994194484762%\" valign=\"top\"\u003e\n \u003cp\u003e4(3.92)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.191582002902758%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.574746008708274%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLack of financial resources\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.44847605224964%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.949201741654571%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.835994194484762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.191582002902758%\" valign=\"top\"\u003e\n \u003cp\u003e0.396\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.574746008708274%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.44847605224964%\" valign=\"top\"\u003e\n \u003cp\u003e40(60.61)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.949201741654571%\" valign=\"top\"\u003e\n \u003cp\u003e13(37.14)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.835994194484762%\" valign=\"top\"\u003e\n \u003cp\u003e54(52.9)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.191582002902758%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.574746008708274%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; No\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.44847605224964%\" valign=\"top\"\u003e\n \u003cp\u003e26(39.39)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.949201741654571%\" valign=\"top\"\u003e\n \u003cp\u003e22(62.96)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.835994194484762%\" valign=\"top\"\u003e\n \u003cp\u003e48(47.05)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.191582002902758%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.574746008708274%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth insurance \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; No\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.44847605224964%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e49(73.13)\u003c/p\u003e\n \u003cp\u003e18(26.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.949201741654571%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e31(88.57)\u003c/p\u003e\n \u003cp\u003e4(11.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.835994194484762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e80(78.4) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22(21.56) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.191582002902758%\" valign=\"top\"\u003e\n \u003cp\u003e0.1127 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.574746008708274%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMisdiagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.44847605224964%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.949201741654571%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.835994194484762%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.191582002902758%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0170\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 3\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e: Univariate and multivariate analysis of sociodemographic factors involved in late diagnosis of prostate cancer\u003c/strong\u003e\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"709\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.966101694915253%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.005649717514125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLong diagnostic delay\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.966101694915253%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.005649717514125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.966101694915253%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.005649717514125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en/N \u0026nbsp; \u0026nbsp;%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRO \u0026nbsp; CI95% \u0026nbsp; \u0026nbsp; \u0026nbsp;P-value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eROa \u0026nbsp; \u0026nbsp; CI95% P-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.966101694915253%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of education\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo education\u003c/p\u003e\n \u003cp\u003eEnrolled in school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.005649717514125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33 \u0026nbsp; \u0026nbsp; \u0026nbsp;32.35\u003c/p\u003e\n \u003cp\u003e69 \u0026nbsp; \u0026nbsp; \u0026nbsp;67.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.504 \u0026nbsp;0.6-3.6 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.966101694915253%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistance between care facilities and home\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt;10 Km\u003c/p\u003e\n \u003cp\u003e10-20 Km\u003c/p\u003e\n \u003cp\u003e\u0026gt;20 Km\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.005649717514125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40 \u0026nbsp; \u0026nbsp;39.22\u003c/p\u003e\n \u003cp\u003e37 \u0026nbsp; \u0026nbsp;36.27\u003c/p\u003e\n \u003cp\u003e25 \u0026nbsp; \u0026nbsp;24.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.81 \u0026nbsp; \u0026nbsp;0.27-2 \u0026nbsp; \u0026nbsp; \u0026nbsp; 0.711 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.89 \u0026nbsp; \u0026nbsp;0.34-2.3 \u0026nbsp; \u0026nbsp; \u0026nbsp;0.82\u003c/p\u003e\n \u003cp\u003e1 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.966101694915253%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth insurance \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.005649717514125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22 \u0026nbsp; \u0026nbsp;21.57\u003c/p\u003e\n \u003cp\u003e80 \u0026nbsp; \u0026nbsp;78.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.29 \u0026nbsp; \u0026nbsp;0.08-1.0 \u0026nbsp; \u0026nbsp;\u003cstrong\u003e0.065\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.54 \u0026nbsp; \u0026nbsp; 0.113-2.58 \u0026nbsp; \u0026nbsp;0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.966101694915253%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFear of cancer diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.005649717514125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37 \u0026nbsp; \u0026nbsp;36.27 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e65 \u0026nbsp; \u0026nbsp;63.72 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.59 \u0026nbsp; \u0026nbsp;0.64-3.9 \u0026nbsp; \u0026nbsp;0.317\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.966101694915253%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLack of financial resources\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.005649717514125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48 \u0026nbsp; \u0026nbsp;47.06\u003c/p\u003e\n \u003cp\u003e54 \u0026nbsp; \u0026nbsp;52.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.44 \u0026nbsp; \u0026nbsp;0.18-1.03 \u0026nbsp; \u0026nbsp;\u003cstrong\u003e0.06\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.58 \u0026nbsp; \u0026nbsp; \u0026nbsp; 0.2-1.706 \u0026nbsp; \u0026nbsp; 0.323\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.966101694915253%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistance from the referral centre\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.005649717514125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25 \u0026nbsp; \u0026nbsp;24.75\u003c/p\u003e\n \u003cp\u003e77 \u0026nbsp; \u0026nbsp;75.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.56 \u0026nbsp; 0.219-1.45 \u0026nbsp; 0.23\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.966101694915253%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLack of information\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.005649717514125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34 \u0026nbsp; \u0026nbsp;32.67\u003c/p\u003e\n \u003cp\u003e68 \u0026nbsp; \u0026nbsp;67.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.75 \u0026nbsp; 0.30-1.8 \u0026nbsp; \u0026nbsp; 0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 4\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eUnivariate and multivariate analysis of knowledge factors involved in the late diagnosis of prostate cancer\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"709\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.694915254237287%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.27683615819209%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLong diagnostic delay\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.694915254237287%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.27683615819209%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.694915254237287%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.27683615819209%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en/N \u0026nbsp; \u0026nbsp; \u0026nbsp;%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRO \u0026nbsp; \u0026nbsp; \u0026nbsp;CI 95% \u0026nbsp; P-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eROa \u0026nbsp; \u0026nbsp; CI95% \u0026nbsp; \u0026nbsp; \u0026nbsp;P-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.694915254237287%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo screening\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.27683615819209%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e98 \u0026nbsp; \u0026nbsp; \u0026nbsp;96.08\u003c/p\u003e\n \u003cp\u003e4 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.76 \u0026nbsp; \u0026nbsp;0.75-7.5 \u0026nbsp; \u0026nbsp;0.812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.694915254237287%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlready heard of prostate cancer\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.27683615819209%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41 \u0026nbsp; \u0026nbsp;40.19\u003c/p\u003e\n \u003cp\u003e61 \u0026nbsp; \u0026nbsp;59.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.52 \u0026nbsp; 0.31-1.8 \u0026nbsp; \u0026nbsp; 0.522\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.694915254237287%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily history of prostate cancer\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.27683615819209%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 \u0026nbsp; \u0026nbsp;17.64\u003c/p\u003e\n \u003cp\u003e84 \u0026nbsp; \u0026nbsp;82.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.18 \u0026nbsp; 0.39-3.49 \u0026nbsp; \u0026nbsp; \u0026nbsp;0.765\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 5\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eUnivariate and multivariate analysis of clinical factors involved in the late diagnosis of prostate cancer\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"709\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.337094499294782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.988716502115656%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.337094499294782%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLong diagnostic delay\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.337094499294782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.37853107344633%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.005649717514125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.966101694915253%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.649717514124294%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.337094499294782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.988716502115656%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en/N \u0026nbsp; \u0026nbsp;%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.337094499294782%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRO \u0026nbsp; \u0026nbsp; \u0026nbsp;CI 95% \u0026nbsp; P-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.337094499294782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eROa \u0026nbsp; \u0026nbsp; CI95% \u0026nbsp; \u0026nbsp; \u0026nbsp;P-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.337094499294782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of staff\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMedical staff\u003c/p\u003e\n \u003cp\u003eTraditional healer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.988716502115656%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.337094499294782%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e0.23 \u0026nbsp; \u0026nbsp;0.08-0.628 \u0026nbsp; \u0026nbsp;\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.337094499294782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.392 \u0026nbsp; \u0026nbsp; 0.12-1.25 \u0026nbsp;0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.337094499294782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMisdiagnosis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.988716502115656%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.337094499294782%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.25 \u0026nbsp; \u0026nbsp; \u0026nbsp;0.10-0.63 \u0026nbsp; \u0026nbsp;\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.337094499294782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.30 \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.10-4.9 \u0026nbsp; \u0026nbsp;\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.337094499294782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecond opinion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.988716502115656%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.337094499294782%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.57 \u0026nbsp; \u0026nbsp; 1.01-6.514 \u0026nbsp; \u003cstrong\u003e0.046\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.337094499294782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.26 \u0026nbsp; \u0026nbsp; \u0026nbsp;1.06-10.1 \u0026nbsp; \u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eData related to late diagnosis of prostate cancer\u003c/h2\u003e\n \u003cp\u003eThe average time for medical consultation was 20.73\u0026thinsp;\u0026plusmn;\u0026thinsp;10.17 months with extremes of 4 and 50 months. It was 3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.46 months with extremes of 20 days and 240 months or 2 years. This delay was 10.39\u0026thinsp;\u0026plusmn;\u0026thinsp;15.05 months with extremes of 1.64 and 114 months or 10.21 years. From the first signs, 57.8% of patients had consulted the doctor while 14.7% of patients had already opted respectively for traditional therapy and 4.9% had sought the advice of a loved one. Among the reasons for consultation, 95 patients presented urinary frequency. There were respectively 64 cases, 47 cases, 45 cases and 41 cases of dysuria, burning when urinating, urine retention and bone pain. Forty-five (45) patients presented with an alteration in their general condition, 33 patients complained of paresthesia and 12 patients had hemospermia. We observed 9 cases and 7 cases respectively of paraparesis and hematuria. All participants with a confirmed histological diagnosis of prostate cancer were all diagnosed at the late stage with 31.37% PT3NxMx stage and 68.63% PT4NxMx stage of the pTNM classification. Acinar adenocarcinoma was found in 99% of cases and squamous cell carcinoma in 1% of cases. In our study, the mean value of the PSA level before any treatment was 521.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1060 ng/ml with extremes of 11ng/ml and 6140 ng/ml. Sixty-seven percent (67%) patients had a PSA level greater than 100 ng/ml. Regarding the histoprognostic grade, 30.4% of patients had a Gleason score of 9.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eFactors associated with late diagnosis of Prostate Cancer with statistical analyzes\u003c/h2\u003e\n \u003cp\u003eAfter comparative analysis, two factors were associated with late diagnosis, namely: the absence of screening for prostate cancer with a p-value of 0.00045, the diagnostic error during the first consultations with a p-value of 0.0170 (Table II). Multivariate analysis of sociodemographic factors revealed that none of these factors was associated with late diagnosis of prostate cancer (Table III). Multivariate analysis of prostate cancer knowledge factors revealed that none was associated with late diagnosis of prostate cancer (Table IV). Multivariate analysis of clinical factors revealed that two of them were associated with late diagnosis of prostate cancer. The first was the diagnostic error (p-value\u0026thinsp;=\u0026thinsp;0.032; OR\u0026thinsp;=\u0026thinsp;1.30; 95% CI [1.10\u0026ndash;4.9]), the second was the taking of a second opinion (p-value\u0026thinsp;=\u0026thinsp;0 .04; OR\u0026thinsp;=\u0026thinsp;3.26; 95% CI [1.06\u0026ndash;10.1] (Table V).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEpidemiological data\u003c/h2\u003e \u003cp\u003eWe identified 102 cases of prostate cancer in a single year. Tengue et al. in 2014 found an annual frequency of 77.3 cases [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This demonstrates a clear increase in the incidence of prostate cancer in Togo. The average age of our patients was 67.79\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5 years with age ranges of 50 and 86 years. The age range [65; 70[ years was the most represented with a percentage of 24.5. Similar age averages were reported by Tengue et al. (68.5 years), as well as Mbey et al. (68.7 years) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Indeed, prostate cancer remains the prerogative of the elderly according to the literature [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A family history of prostate cancer was noted in 17.7% of patients. Darr\u0026eacute; et al. found a family history of prostate cancer in 41.38% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData related to late diagnosis of prostate cancer\u003c/h2\u003e \u003cp\u003eFunctional urinary signs were the most frequently recorded revealing signs with 95 cases of pollakiuria and 6 4 cases of dysuria. These results are similar to those of Tengue et al. who described symptoms of the lower urinary tract in 89.2% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Darr\u0026eacute; et al. had also found functional urinary signs in 37.93% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This high frequency of functional urinary disorders could be explained by the fact that they constitute a nuisance in daily life forcing the patient to consult. Bone pain and deterioration of general condition were found in 41 cases and 47 cases respectively. Tengue et al. also found an alteration of the general condition respectively in 82.3% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Overall, the existence of functional manifestations during prostate cancer disease would reflect an advanced stage of this pathology [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The TNM classification was specified in all our respondents, which allowed us to establish the classification into stages. The entire series consisted only of advanced cases, classified stage PT3NxMx (31.37%) and pT4NxMx (68.63%). These results are similar to those reported by Tengue et al. which found 75.9% of metastasized tumors [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Likewise Sine et al. found 96.5% of advanced cancers [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The current trend shows that approximately 15% of patients with prostate cancer are diagnosed at an advanced stage [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Histologically, these were adenocarcinomas in 99% and squamous cell carcinoma in 1%. These were only adenocarcinomas in the series by Darr\u0026eacute; et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A predominance of prostate adenocarcinomas was also reported by Ndoye et al. in 97.7% of cases [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. According to the literature, prostate adenocarcinoma represents more than 90% of cases of prostate cancer; squamous cell carcinoma and neuroendocrine carcinoma being very rare [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The Gleason score was specified in all patients. In our study, ISUP grade 5 corresponding to Gleason score 9 was the most represented with 30.39%. Bouanika et al. as well as boulfhrad et al. also reported a predominance of score 9 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The average PSA level at the time of diagnosis was 521.39 ng/ml with extremes of 11 and 6140.5 ng/ml). Omisanjo et al. found a similar mean PSA of 563.2ng/ml [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Niang et al. as well as Sine et al. found a mean PSA value before any treatment of 1447.57 ng/ml and 1367 ng/ml respectively [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Screening for prostate cancer in the presence of elevated serum PSA levels has been used in men aged over 50 years since at least 1992 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Indeed, screening based on prostate specific antigen (PSA) is one of the most common methods of diagnosing prostate cancer. However PSA expression has also been reported in other tissues such as normal prostate epithelium, small intestine, kidney cells and salivary organs, but the expression level in these parts is 100 to 1000 times lower than that of prostate cancer [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In 2018, the U.S. Preventive Services Task Force suggested that for all men aged 70 and older, prostate cancer screening based on a PSA blood test be suspended; for men aged 55 to 69, individual screening based on an informed discussion with the doctor and no screening for men under 55 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In routine practice, guidelines are often not followed and one of the main reasons for this is the lack of knowledge of the recommendations among primary care general practitioners [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. These generally high PSA levels in our context could be explained by an often late diagnosis.\u003c/p\u003e \u003cp\u003eIn our series, only 36.3% of patients had to travel a distance of more than 20 km compared to 67.7% who had traveled distances between 0 and 20 km as part of a consultation in a health structure. These results show us that patients living far away consulted less. Also Amborggi et al. reported that the burden of travel between a patient's residence and health centers was an important problem that could influence the early diagnosis and choice of cancer treatment [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Thomas et al. demonstrated that travel burden (measured as travel distance or time) can lead to diagnostic delays and can influence treatment choice for a variety of common cancers [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In the series by Kabor\u0026eacute; et al. patients with poor geographic access or living in rural areas (18.3%) were twice as likely to have advanced stages of cancer than urban residents (9.6%) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Only 3.92% of our respondents were aware of screening and the means of screening for prostate cancer. This result is much lower than that reported by Kabor\u0026eacute; et al. which was 29.7% [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In the series by Darr\u0026eacute; et al. 51.43% of participants had no knowledge of the PSA blood test, with a statistically significant correlation between this knowledge of the PSA blood test with the level of study and the effectiveness of an internship in a health service. urology [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In our study we had difficulty determining the precise consultation period because patients cannot remember exactly the duration before their first consultations. Nevertheless, we used the medical records of these patients. The average consultation time in our series was 20.73\u0026thinsp;\u0026plusmn;\u0026thinsp;10.17 months. The majority of patients (53.9%) consulted within less than 21 months compared to 46.1% who consulted beyond 21 months. This could be explained on the one hand by the fact that in our society we consider that urinary problems are normal with age; on the other hand, by the lack of knowledge of the signs of the pathology, illiteracy, the preeminence of traditional therapy and by the poverty of the population, the vast majority of which is rural or unemployed in our country. Factors such as poverty, religion, culture, communication barriers, language and costs are thought to affect men's participation in prostate cancer screening [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with late diagnosis of Prostate Cancer with statistical analyzes\u003c/h2\u003e \u003cp\u003eAfter univariate analysis, five factors were associated with the long diagnosis delay, namely the absence of health insurance, lack of financial means, type of first consultation, diagnostic error and taking a second opinion. Multivariate analysis of all these parameters reveals that two factors were associated with late diagnosis of prostate cancer. The first factor was diagnostic error (with a p-value\u0026thinsp;=\u0026thinsp;0.032; ORa\u0026thinsp;=\u0026thinsp;1.30; 95% CI [1.10\u0026ndash;4.9]). Thus, for a patient whose initial diagnosis was other than prostate cancer, there would be a 30% higher risk of late diagnosis. This may be explained by insufficient knowledge of the signs and symptoms of prostate cancer by healthcare providers, especially at the primary level. The second factor was the taking of a second opinion (with p-value\u0026thinsp;=\u0026thinsp;0.04; OR\u0026thinsp;=\u0026thinsp;3.26; 95% CI [1.06\u0026ndash;10.1]; which means that a patient whose initial diagnosis required a second opinion, would have a 3.26 higher risk of late diagnosis. This second opinion may be linked on the one hand to a lack of information and awareness and on the other hand to the strong cultural tendency of population towards traditional therapy. The existence of health insurance would promote early diagnosis [\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Kabore et al. reported the lack of screening program and the insufficiency of the technical platform as associated with the late diagnosis of prostate cancer in our African context [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003e The study was carried out among patients followed for prostate cancer in the urology department of the Sylvanus Olympio University Hospital Center (CHU) in Lom\u0026eacute;; which limits its representativeness to other patients outside this center or in different care contexts. The results cannot be generalized to all patients with prostate cancer in Togo. The convenience sampling method used in the study may introduce selection bias because participants were chosen based on their availability and access to health care. The data was collected using a questionnaire developed on the basis of a literature review and translated into different languages for a better understanding of the respondents, which may introduce information bias. Participants' responses may be influenced by comprehension errors linked to approximate translations of the questions or by a desire to provide socially acceptable answers.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eProstate cancer is a current problem in Togo, often diagnosed at a late stage. A total of two factors have been identified as associated with this late diagnosis of prostate cancer; in this case the diagnostic error which can be explained by insufficient knowledge of the signs and symptoms of the pathology by healthcare providers especially at the primary level and the insufficiency of the technical platform; as well as getting a second opinion. It would be wise to assess and upgrade healthcare providers' knowledge of new diagnostic techniques for prostate cancer.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eISUP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Society of Urological Pathology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePSA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAntigen Specific of Prostate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eTNM\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTumor Node Metastasis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the “Comité de Bioéthique pour la Recherche en Santé (CBRS)” (Bioethics Committee for Health Research) from the Togo Ministry of Health, Ref N0: 0101/2016/MS/CAB/DGS/DPLET/CBRS).All patients and relatives of patients had received information on the purpose and procedures of this study and provided written and informed consent.\u0026nbsp;The study has been carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExtracted data are with the corresponding author and available under reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eT. D was responsible for the conception of the study; participated in the study design; undertook the field study; conducted the data collection, analysis, and interpretation; and wrote the manuscript T.Dj., E.P., P.S.,B.S., M.B., and E.S. were involved in the data collection, analysis, and interpretation. They wrote and finalized the manuscript. G.N.K. is responsible for the overall scientific management of the study, for analysis and interpretation, and for the preparation of the final manuscript. All authors have read and approved the final manuscript for submission for publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSchatten H. Brief Overview of Prostate Cancer Statistics, Grading, Diagnosis and Treatment Strategies. Adv Exp Med Biol. 2018;1095:1‑14.\u003c/li\u003e\n \u003cli\u003eWasim S, Lee SY, Kim J. Complexities of Prostate Cancer. 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Prim Care. 2019;46(2):257‑63.\u003c/li\u003e\n \u003cli\u003eUS Preventive Services Task Force, Grossman DC, Curry SJ, Owens DK, Bibbins-Domingo K, Caughey AB, et al. Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(18):1901‑13.\u003c/li\u003e\n \u003cli\u003eBellier T, Vallard A, Espenel S, Langrand-Escure J, Ben Mrad M, V\u0026eacute;drine L, et al. [Role of general practitioners in cancer screening: A survey in the French armed forces]. Bull Cancer (Paris). d\u0026eacute;c 2015;102(12):993‑1001.\u003c/li\u003e\n \u003cli\u003eEl Fakir S, Abda N, Najdi A, Bendahou K, Obtel M, Berraho M, et al. [Cancer screening practices of general practitioners working in the Fez Prefecture health center]. Sante Publique Vandoeuvre--Nancy Fr. 2013;25(5):685‑91.\u003c/li\u003e\n \u003cli\u003eAmbroggi M, Biasini C, Del Giovane C, Fornari F, Cavanna L. Distance as a Barrier to Cancer Diagnosis and Treatment: Review of the Literature. The Oncologist. 2015;20(12):1378‑85.\u003c/li\u003e\n \u003cli\u003eThomas AA, Gallagher P, O\u0026rsquo;C\u0026eacute;illeachair A, Pearce A, Sharp L, Molcho M. Distance from treating hospital and colorectal cancer survivors\u0026rsquo; quality of life: a gendered analysis. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2015;23(3):741‑51.\u003c/li\u003e\n \u003cli\u003eKabore FA, Kambou T, Zango B, Ou\u0026eacute;draogo A. Knowledge and awareness of prostate cancer among the general public in Burkina Faso. J Cancer Educ Off J Am Assoc Cancer Educ. 2014;29(1):69‑73.\u003c/li\u003e\n \u003cli\u003eDarr\u0026eacute; T, Djiwa T, Kpatcha TM, Sidib\u0026eacute; A, Sewa E, Botcho G, et al. Prostate cancer screening: A survey of medical students\u0026rsquo; knowledge in Lome, Togo, and associated determinants in a resource-limited African context. SAGE Open Med. 2021;9:20503121211032812.\u003c/li\u003e\n \u003cli\u003eMumuni S, O\u0026rsquo;Donnell C, Doody O. The Risk Factors and Screening Uptake for Prostate Cancer: A Scoping Review. Healthc Basel Switz. 2023;11(20):2780.\u003c/li\u003e\n \u003cli\u003eSingh K, Abdel Goad EH, Ramklass SS. Waiting times for prostate cancer diagnosis in KwaZulu-Natal, South Africa. South Afr Med J Suid-Afr Tydskr Vir Geneeskd. 2015;105(6):484‑6.\u003c/li\u003e\n \u003cli\u003eOsowiecka K, Nawrocki S, Kurowicki M, Rucinska M. The Waiting Time of Prostate Cancer Patients in Poland. Int J Environ Res Public Health. 2019;16(3):342.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"prostate cancer, late diagnosis, associated factors, Togo. ","lastPublishedDoi":"10.21203/rs.3.rs-4699979/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4699979/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e : Prostate cancer represents a real public health issue in countries with limited resources and is often diagnosed at late stages. The aim of the study was to determine the factors associated with late diagnosis of prostate cancer in Togo.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This was a cross-sectional study with a descriptive and analytical, relating to cases of prostate cancer, diagnosed in the Urology department and histologically confirmed at the Pathological Anatomy and Cytology Laboratory of the Lomé; from April 4, 2022 to April 28, 2023, in Togo.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total, 102 cases of prostate cancer were recorded. The average age was 67.79 ± 8.5 years. The mean PSA level was 521.3933±1060 ng/ml. Histologically, it was acinar adenocarcinoma in 99.02%. All patients in our study were diagnosed at the late stage with 31.37% pT3NxMx stage and 68.63% pT4NxMx stage of the pTNM classification. It was Gleason score 9 in 31 patients (30.39%). After multivariate analysis, two factors were associated with late diagnosis of prostate cancer : diagnostic error (p-value = 0.032; ORC = 1.30; 95% CI [1.10-24.9]); taking a second opinion (p-value = 0.0170; ORa = 2.62; 95% CI [2.01-4.7]). However, factors involving easy access to the health system before prostate cancer diagnosis appear to be major protective factors for diagnosis at an advanced stage of disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The diagnosis error and the taking of a second opinion are the factors on which it will be necessary to act to make an early diagnosis of prostate cancer in our context.\u003c/p\u003e","manuscriptTitle":"Factors associated with late diagnosis of prostate cancer in Togo, Sub-Saharan Africa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-31 08:23:45","doi":"10.21203/rs.3.rs-4699979/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ebd6b53c-8d11-409d-bd93-86fe6be61f6b","owner":[],"postedDate":"July 31st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-27T06:25:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-31 08:23:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4699979","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4699979","identity":"rs-4699979","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}