Abstract Background: Prostate cancer is often diagnosed early in high-income countries (HICs), leading to better outcomes. In contrast, most men in sub-Saharan Africa (SSA) present with advanced-stage disease, contributing to poor survival rates. This disparity is a result of interacting and overlapping systemic and infrastructural deficiencies. Identifying predictors of late diagnosis is essential to improving prostate cancer outcomes across SSA settings. This review summarizes prevailing predictors of late diagnosis of prostate cancer in SSA and emerging opportunities for healthcare system strengthening and improved outcomes. Methods: We conducted a narrative review of published literature relevant to prostate cancer in SSA over the last decade to characterize the current landscape of diagnosis. A comprehensive literature search was conducted using databases such as PubMed, Web of Science, and Google Scholar. We focused on identifying predictors of late diagnosis of prostate cancer in SSA and feasible interventions. Results: Studies consistently show that between 65% and 90% of men in the region present with advanced or metastatic disease at the time of diagnosis, far exceeding rates in high-income countries. The review revealed that a combination of patient-related, health system, and socio-cultural factors drives late diagnosis of prostate cancer in SSA. Low levels of awareness about prostate cancer symptoms and the benefits of early detection were consistent predictors identified among 60% to 75% of men. Limited access to PSA testing, specialist care, and diagnostic facilities, especially in rural areas, was frequently reported, with only 20% to 35% of men having ever undergone PSA testing or prostate cancer screening. Financial constraints, lack of health insurance, and long travel distances to healthcare centers were reported by 50% to 70% of patients. Cultural beliefs, fear of cancer diagnosis, stigma, and reliance on traditional or alternative medicine delayed presentation in an estimated 30% to 50% of cases. In addition, for those who manage to present in early disease, they often end up being managed late due to several other systemic delays. Conclusion: Low awareness, healthcare barriers, and socio-cultural factors are responsible for the late diagnosis of prostate cancer in SSA. Strengthening health systems through improved screening, decentralizing diagnostic services, training specialists, and enhancing public education offers opportunities to promote earlier detection and improve outcomes. Investing in these areas can help bridge the gap with HICs and reduce the burden of advanced prostate cancer in SSA. Citation Format: Ayodeji O. Ojetunde, Moyinoluwa Akinwumi, Janet Tijani, Clement Awe, James O. Alabi, Favour Okoye, Zeribe C. Nwosu. Predictors of late diagnosis of prostate cancer in sub-saharan Africa: Opportunities to improve outcomes abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C130.
Ojetunde et al. (Thu,) studied this question.