Abstract
Background
Prostate cancer is a leading cause of cancer-related morbidity and mortality among men worldwide. Despite its growing burden, screening uptake remains low in many low- and middle-income countries, including Ethiopia. Early detection through screening is essential, yet awareness and access remain limited.
Methods
This systematic review and meta-analysis followed PRISMA guidelines. We searched PubMed, Scopus, Web of Science, AJOL, and Google Scholar for studies published 30 August 2025 using terms related to prostate cancer, screening, and Ethiopia. Observational studies of prostate cancer screening were included. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle–Ottawa Scale. Pooled prevalence was estimated with a random-effects meta-analysis; heterogeneity and publication bias were evaluated using I² and funnel plots with Egger’s test. Significant factors were summarized narratively.
Results
Twelve studies, including 7526 participants from Addis Ababa, Southern, Central, and Amhara regions, were analyzed. The pooled prevalence of prostate cancer screening was 30.37% (95% CI: 20.49–40.25% I² = 96.7%, p < 0.001). Subgroup analysis showed the highest prevalence in the Wolaita Sodo (63.08%, 95% CI: 58.73–69.22%), followed by Amhara region (47.97%( 95% CI: 42.02–53.92), and the lowest in central Ethiopia region (7.19%, 95% CI: 4.75–9.67%). Significantly associated factors included awareness of prostate cancer screening (AOR = 3.36, 95% CI: 1.87–6.85), age of the patients > 45 years (AOR = 3.53, 95% CI: 1.69–5.46), regular checkup of cancer (AOR = 3.65, 95% CI: 1.09–6.20), average income ≥ 5000 ETB (AOR = 3.80, 95% CI: 2.28–5.31), family history of prostate cancer (AOR = 3.87,95% CI: 2.30–5.45), and ever heard about prostate cancer (AOR = 3.15,95% CI: 1.43–4.88). Conclusion: Prostate cancer screening in Ethiopia remains low, with marked regional differences. Uptake is higher among older men, those with higher income, prior awareness, family history, or regular health checkups. Targeted educational programs and improved access to screening are urgently needed. Nationwide, longitudinal, and mixed-method studies are essential to evaluate interventions and understand behavioral, cultural, and systemic factors affecting screening practices.
Conclusion
Prostate cancer screening in Ethiopia remains low, with marked regional differences. Uptake is higher among older men, those with higher income, prior awareness, family history, or regular health checkups. Targeted educational programs and improved access to screening are urgently needed. Nationwide, longitudinal, and mixed-method studies are essential to evaluate interventions and understand behavioral, cultural, and systemic factors affecting screening practices.
Keywords: Prostate cancer, Screening practices, Associated factors, Ethiopia
Introduction
Prostate cancer is a malignant tumor of the prostate gland, a small, walnut-shaped organ in the male reproductive system [1]. Prostate cancer is a leading cause of morbidity and mortality among men worldwide. Often asymptomatic until advanced stages, it presents significant challenges for early detection and management. The disease predominantly affects men over 50 and ranks among the most commonly diagnosed cancers globally [2, 3]. According to GLOBOCAN 2020, prostate cancer is the second most frequently diagnosed cancer among men and the fifth leading cause of cancer-related deaths, with over 1.4 million new cases and approximately 375,000 deaths annually. Key risk factors include advancing age, family history, African ancestry, genetic predisposition, and lifestyle factors such as diet and physical activity [4–6].
The burden of prostate cancer varies by region. Developed countries report higher incidence due to widespread screening and early detection, whereas low- and middle-income countries, including many in Africa, experience disproportionately high mortality, as diagnoses often occur at advanced stages [1, 7, 8]. In Africa, prostate cancer is the most commonly diagnosed cancer among men, with incidence rising due to increased life expectancy, urbanization, lifestyle changes, and improved cancer reporting. Mortality remains high, particularly in Sub-Saharan Africa, where age-standardized rates exceed those in high-income countries by more than twofold. Barriers to early detection and management include limited awareness of symptoms and risk factors, low screening uptake, absence of organized programs, inadequate healthcare infrastructure, cultural beliefs, stigma, and restricted access to healthcare services [9–12].
Globally, prostate cancer is the most frequently diagnosed malignancy among men in 118 countries, including several within sub-Saharan Africa. However, it is the leading cause of cancer-related deaths in only 52 countries, reflecting regional disparities in early detection, prevalence of risk factors, and availability of effective treatment and care services. These variations highlight inequities in health system capacity and access to prostate cancer screening across different settings [3].
In Ethiopia, prostate cancer holds a significant position in the national cancer landscape. In 2019, it was the second most commonly diagnosed cancer among men, with 2570 new cases reported, following leukemia with 4330 cases. The age-standardized incidence rate for prostate cancer was 14.5 per 100,000 men. It also represented the second leading cause of cancer-related deaths among Ethiopian men, with 2290 deaths recorded in the same year, and the highest age-standardized mortality rate of 13.8 per 100,000 men [13, 14].
These statistics underscore the urgent need to strengthen prostate cancer awareness, early detection, and screening initiatives in Ethiopia to improve diagnosis at earlier stages, enhance treatment outcomes, and reduce mortality associated with the disease [15].
In Ethiopia, prostate cancer ranks among the top three cancers affecting men. Although potentially curable if detected early, it is often diagnosed at advanced stages, leading to poor outcomes, high mortality, and considerable psychosocial burden. Systemic challenges including shortages of trained healthcare professionals, limited diagnostic resources such as PSA testing, and restricted access to treatments like surgery, radiotherapy, and hormone therapy—exacerbate this burden. Low awareness, cultural misconceptions, and poor health-seeking behaviors, especially in rural and underserved areas, further delay early detection [9, 13, 16, 17].
Regional studies from Central Ethiopia (Hosanna), Amhara, Southern Ethiopia, and Tikur Anbessa hospitals consistently report low awareness and minimal uptake of prostate cancer screening. Rural populations are particularly affected due to limited access to healthcare, diagnostic services, and health education. Sociocultural factors including stigma, fatalistic beliefs, and misconceptions about cancer further delay care-seeking. Existing initiatives, such as awareness campaigns, healthcare provider training, and pilot screening programs, remain fragmented, small-scale, and largely urban-focused. Currently, Ethiopia lacks a national guideline or coordinated public health strategy for prostate cancer screening and early detection [13, 15, 16, 18, 19].
Prostate cancer screening uptake in Ethiopia remains critically low, with regional studies highlighting substantial gaps in awareness and practice. For instance, only a small fraction of men in Hosanna Town had ever undergone screening, whereas in Mizan Aman Town, awareness was higher but strongly associated with younger age, government employment, and higher income [15]. At Tikur Anbessa Specialized Hospital, knowledge of prostate cancer risk factors, symptoms, screening methods, and prevention ranged from 41% to 50%, with higher awareness observed among men who had access to healthcare information or possessed higher socioeconomic status [19, 20]. Although systematic reviews across Sub-Saharan Africa report moderate knowledge and awareness, screening practices remain low, and no review has focused specifically on Ethiopia [15, 20, 21]. The evidence is fragmented, regionally limited, and methodologically diverse, highlighting a critical gap: the absence of a national-level synthesis of prostate cancer screening prevalence and its associated factors [22]. An Ethiopia-specific systematic review and meta-analysis is therefore urgently needed to consolidate findings, determine overall screening rates, identify key determinants, and guide evidence-based public health policies and interventions [23, 24].
Although several studies have explored awareness, screening practices, and associated factors, the evidence remains fragmented, regionally limited, and methodologically inconsistent. This lack of comprehensive, nationally representative data hinders accurate assessment of prostate cancer screening prevalence and the identification of key determinants across Ethiopia. A systematic review and meta-analysis is therefore urgently needed to consolidate existing evidence, provide robust national estimates, and clarify the main barriers and facilitators influencing screening behavior. Such evidence is essential for guiding targeted interventions, shaping effective public health policy, and ultimately reducing the burden of prostate cancer-related morbidity and mortality in the country.
Methods
Search strategy
A comprehensive and systematic literature search was conducted to identify studies on prostate cancer screening practices and associated factors in Ethiopia. The search aimed to compile both regional and national evidence to determine the prevalence of screening and identify key influencing determinants. Electronic databases PubMed, PubMed Central (PMC), African Journals Online (AJOL), and the Directory of Open Access Journals (DOAJ) were systematically searched for relevant articles published 30 August 2025. A combination of Medical Subject Headings (MeSH) terms and free-text keywords was employed, including “prostate cancer screening Ethiopia,” “prostate cancer awareness Ethiopia,” “prostate cancer knowledge Ethiopia,” “prostate cancer practice Ethiopia,” and “prostate cancer Ethiopia cross-sectional.” Boolean operators (AND, OR) were used to refine the search strategy. In addition, manual screening of reference lists from the included studies was performed to identify any other eligible and relevant articles not captured through database searches.
Eligibility selection criteria
Inclusion criteria
The inclusion criteria were restricted to studies conducted among Ethiopian populations, published in English, and focused on awareness, knowledge, or screening practices related to prostate cancer. Eligible studies included original quantitative research designs, such as cross-sectional, cohort, or case-control studies, that reported measurable outcomes on screening behaviors and the factors influencing prostate cancer screening practices.
Exclusion criteria
Studies were excluded if they were not peer-reviewed or lacked original data, involved non-Ethiopian populations or did not report Ethiopia-specific findings, or were non-original publications, including reviews, editorials, opinion pieces, commentaries, or conference abstracts without full data. Applying these criteria ensured that the analysis was based on primary, relevant, and reliable evidence. Several regional studies meeting these standards were identified, revealing substantial variation in prostate cancer awareness and screening practices across different parts of Ethiopia.
Operational definitions
Awareness of prostate cancer
The degree to which men know about prostate cancer, including its risk factors, symptoms, potential complications, and the importance of early detection. Awareness is typically measured through self-reported questionnaires or structured interviews assessing knowledge levels [19].
Screening practices
The actual behaviors or actions of men regarding prostate cancer detection, including whether they have ever undergone screening (e.g., Prostate-Specific Antigen [PSA] test, Digital Rectal Exam [DRE]), frequency of screening, and adherence to recommended screening guidelines [15].
Influencing factors
The demographic, socio-economic, cultural, and health-system variables that affect awareness or screening behaviors. Examples include age, education level, income, and marital status, and urban/rural residence, access to healthcare facilities, physician recommendation, and cultural beliefs [25].
Ethiopia-specific context
For this review, all studies included must report data from Ethiopian men or provide Ethiopia-specific findings, ensuring that conclusions are relevant to the local healthcare and cultural context [26].
Quality evaluation and data gathering
The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for the critical appraisal of included studies [27]. Titles and abstracts were first screened to assess potential eligibility. Articles meeting the initial criteria underwent a detailed full-text review to determine final inclusion.
The Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI) critical appraisal tools (The Joanna Briggs Institute, Adelaide, Australia) were applied to evaluate the methodological quality of all studies that met the inclusion criteria. The appraisal criteria were adapted for reporting prevalence data and cross-sectional study designs.
All authors independently assessed the titles and abstracts against predefined selection criteria, followed by full-text quality appraisal. Studies with a quality evaluation score of seven or higher were considered to have a low risk of bias (Table 1). Any disagreements between reviewers during the assessment process were resolved through discussion, and when necessary, consultation with additional reviewers.
Table 1.
Critical appraisal results of eligible studies on the awareness, screening practices, and determinants of prostate cancer in ethiopia: a systematic review and meta-analysis
| Authors | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | Q9 | Total |
|---|---|---|---|---|---|---|---|---|---|---|
| Gebru et al. | Y | Y | Y | Y | Y | N | Y | Y | Y | 8 |
| Shanko et al. | Y | N | Y | Y | Y | Y | Y | Y | Y | 8 |
| Assefa et al. | Y | Y | Y | Y | Y | Y | Y | U | Y | 8 |
| Bantie et al. | Y | Y | Y | Y | Y | Y | Y | Y | Y | 9 |
| Alemayehu et al. | Y | Y | Y | Y | Y | Y | Y | Y | Y | 9 |
| Gebremichael & Abebe | Y | Y | Y | Y | N | Y | Y | Y | Y | 8 |
| Gebre, Gebrie, Bedru & Bennat | Y | Y | Y | Y | Y | Y | U | Y | Y | 8 |
| Gebretsadik, Bogale & Dulla | Y | Y | Y | Y | Y | Y | Y | U | Y | 8 |
| Abebe et al. | Y | N | Y | Y | Y | Y | Y | Y | Y | 8 |
| Molla et al. | Y | Y | Y | Y | Y | Y | Y | Y | Y | 9 |
| Tadesse & Tessema | Y | Y | Y | Y | Y | Y | Y | Y | Y | 9 |
| Wassie et al. | Y | Y | Y | Y | Y | N | Y | Y | Y | 8 |
Data extraction and quality assessment
Data extraction was independently performed by two reviewers using a standardized form adapted from the 2014 Joanna Briggs Institute Reviewers’ Manual [27]. The extraction tool, developed by three authors (TL, and MG), captured essential details including study title, author, year of publication, study design, sample size, participants, study setting, response rate, and, where relevant, key outcome measures such as prostate cancer screening rates or the percentage of Ethiopian nurses knowledgeable in wound care. Articles that met the predefined inclusion criteria were selected for the final analysis. To ensure data accuracy and consistency, all extracted information was double-checked by the reviewers, and any discrepancies were resolved through discussion or consultation with a third reviewer.
The methodological quality of included studies was assessed using the Newcastle–Ottawa Scale (NOS) for observational studies, focusing on domains of selection, comparability, and outcome assessment. Additionally, the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was applied where appropriate to further evaluate study quality and risk of bias. Disagreements regarding quality ratings were resolved by consensus among the review team. This rigorous process ensured reliability in both data extraction and quality appraisal across all studies included in the review.
Methodological quality evaluation
The methodological quality of included studies was assessed using a modified and established checklist adapted for evaluating knowledge- and practice-related research, with each item scored as “Yes” (met requirements), “No” (did not meet requirements), or “Unclear” (did not meet requirements but adequately represented the parameter). Studies rated as “No” or “Unclear” were excluded from the systematic review and meta-analysis. Additionally, the JBI-MAStARI tool was applied to evaluate risk of bias, and for cross-sectional studies, a Newcastle-Ottawa Scale (NOS) score of seven or higher out of nine was considered acceptable, indicating a low risk of bias [27, 28].
Quality assessment criteria
The following nine questions were used to evaluate methodological quality for studies on client satisfaction and associated factors with clinical laboratory services in Ethiopia:
Was the sample frame appropriate to address the target population?
Were study participants sampled appropriately?
Was the sample size adequate?
Were the study subjects and the setting described in detail?
Was the data analysis conducted with sufficient coverage of the identified sample?
Were valid methods used for the identification of the condition?
Was the condition measured in a standard, reliable way for all participants?
Was appropriate statistical analysis used?
Was the response rate adequate, and if not, was the low response rate managed appropriately?
Statistical analysis
Statistical analyses were conducted using a random-effects meta-analysis model to account for variability between studies and provide more generalized estimates. The primary outcomes pooled were the prevalence of prostate cancer awareness and screening practices among Ethiopian men. Forest plots were generated to visually display the individual study estimates along with their 95% confidence intervals and the overall pooled prevalence. To evaluate the consistency of findings across studies, statistical heterogeneity was assessed using the I² statistic, which quantifies the percentage of total variation due to heterogeneity rather than chance, and Cochran’s Q test. An I² value greater than 50% was considered indicative of substantial heterogeneity.
Due to differences in study designs, populations, and measurement methods, a random-effects model was preferred over a fixed-effects model to accommodate this heterogeneity. Subgroup analyses or meta-regression were planned if sufficient data were available to explore sources of heterogeneity.
In addition to the quantitative synthesis, a narrative synthesis was performed to summarize qualitative findings related to factors associated with prostate cancer screening uptake. This included an examination of significant predictors such as knowledge, awareness, sociodemographic factors, and barriers reported across studies. The narrative approach allowed for integration of diverse study findings and contextual interpretation, which is essential for understanding the complex influences on screening behavior in the Ethiopian setting.
Results
Studies have found
In this review, 7522 articles were retrieved through internet searching (Pub Med, Google scholar, UCSF, and Ethiopian University repository online). Twenty-nine were identified through other sources. Totally, 7551 articles were retrieved. Out of these, 171 duplicate records were removed from the review. Of the total articles, 3236 were due to inaccuracy title and 3391 articles were due to absence similarity of abstracts were excluded from the review. After a full review of the articles, 741 were excluded by eligibility criteria. Finally, 12 articles fulfill the inclusion criteria were used to determine the pooled prevalence of prostate cancer awareness and screening practices among Ethiopian men (Fig. 1).
Fig. 1.
PRISMA diagram of selecting and including studies on prostate cancer awareness, screening practices, and influencing factors in Ethiopia: a systematic review and meta-analysis
Characteristics of searched studies
This systematic review and meta-analysis included 3812 study participants from 12 studies that evaluated the prevalence of prostate cancer awareness and screening practices among Ethiopian men. According to the regional distribution of the articles found `by searching, three from Amhara, three from AA, one Oromia, and three from South Ethiopia were included (Table 2).
Table 2.
Characteristics of studies on the awareness, screening practices, and determinants of prostate cancer in ethiopia: a systematic review and meta-analysis
| author | year | region | study area | Study period | S.design | sample | cases | Outcome (%) |
|---|---|---|---|---|---|---|---|---|
| Gebru et al. | 2023 | Addis Ababa | TASH | Feb–Apr 2021 | CS | 241 | 108 | 44.7 |
| Shanko et al. | 2022 | Central | Hosna | May–Jun 2022 | CS | 417 | 30 | 7.2 |
| Assefa et al. | 2022 | Southern | Mizan Aman | Apr-19 | CS | 322 | 206 | 64 |
| Bantie et al. | 2022 | Amhara | Bahir Dar | May–Jun 2019 | CS | 845 | 232 | 27.5 |
| Alemayehu et al. | 2020 | Amhara | Bahir Dar | 2019 | CS | 300 | 120 | 40 |
| Gebremichael & Abebe | 2018 | Amhara | Bahir Dar | 2017 | CS | 280 | 28 | 10 |
| Gebre, Gebrie, Bedru & Bennat | 2023 | Sidama | Hawassa | Oct 15 – Nov 15, 2021 | CS | 143 | 27 | 18.9 |
| Gebretsadik, Bogale & Dulla | 2023 | Sidama | Hawassa | 2013–2019 (RS) | RS | 207 | 44 | 21.3 |
| Abebe et al. | 2021 | Amhara | Gondar | Jan–Mar 2021 | CS | 350 | 133 | 38 |
| Molla et al. | 2020 | Amhara | Gondar | 2019 | CS | 300 | 36 | 12 |
| Tadesse & Tessema | 2019 | Amhara | Gondar | 2018 | CS | 250 | 85 | 34 |
| Wassie et al. | 2024 | Amhara | Northwest | Dec 2019–Dec 2020 | CS | 271 | 130 | 48 |
NB = HZH Hadiya Zone Hospitals, PP prevalence percentage, SD study design, SS sample size, 3 Hospitals (TASH, UOGH, JUH)
The heterogeneity of publications
The funnel plot test, I2, and its accompanying p-value were used to determine the degree of heterogeneity. The heterogeneity test results were classified as low, medium, and high heterogeneity using values of 25%, 50%, and 75%. A random effect analysis model was utilized for results that were statistically significant for heterogeneity. To evaluate the statistical importance of publication bias, an asymmetry test and Egger regression were used.
Prevalence of prostate cancer screening (systemic review and meta-analysis)
A systematic search identified a total of 12 eligible studies examining prostate cancer awareness, knowledge, and screening practices among Ethiopian men.
The pooled prevalence of prostate cancer screening was 30.37% (95% CI: 20.49–40.25% I² = 96.7%, p < 0.001) (Fig. 2).
Fig. 2.
Forest plot on the prevalence of prostate cancer screening and determinants among cancer patients in Ethiopia: a systematic review and meta-analysis
Subgroup analysis of prostate cancer screening in Ethiopia
We have performed subgroup analysis based on regions where the studies were carried out. Based on subgroup analysis, the highest pooled prevalence is in the Wolaita Sodo (63.08%, 95% CI: 58.73–69.22%), followed by Amhara region (47.97%(95% CI: 42.02–53.92), and the lowest in central Ethiopia region (7.19%, 95% CI: 4.75–9.67%) respectively (Fig. 3).
Fig. 3.
Subgroup plot on the prevalence of prostate cancer screening and determinants among cancer patients in Ethiopia: a systematic review and meta-analysis
Heterogeneity and publishing bias
The I2 (variation in ES attributable to heterogeneity) test results revealed that there was considerable heterogeneity with I2 = 99.3%, at p-value ≤ 0.001. The funnel plot results showed that the included studies were distributed consistently upon inspection, indicating that there was no risk for publication bias (Egger’s test: b = (2.55), p = 0.031) (Fig. 4).
Fig. 4.
Funnel plot test (a) and egger test (b) on the prevalence of prostate cancer screening and determinants among cancer patients in Ethiopia: a systematic review and meta-analysis
Sensitive analysis of prevalence of cancer screen among cancer patients in Ethiopia. Used a random effect to conduct the test, and the outcomes revealed that no single study had an impact on the overall pooled prevalence of cancer screen among cancer patients in Ethiopia (Fig. 5).
Fig. 5.
Sensitive analysis on the prevalence of prostate cancer screening and determinants among cancer patients in Ethiopia: a systematic review and meta-Analysis
Factors associated with cancer screen among cancer patients in Ethiopia
The related factors of cancer screen among cancer patients in Ethiopia were carefully evaluated and meta-analyzed using ten relevant researches. This review identified different contributing factors, which included awareness of prostate cancer screening, age of the patients > 45 years, regular checkup of cancer, average income ≥ 5000 ETB, family history of prostate cancer, and ever heard about prostate cancer patients in Ethiopia.
Patients with good awareness of prostate cancer screening had significantly higher odds of undergoing screening compared to those with poor awareness (AOR = 3.36, 95% CI: 1.87–6.85) (Fig. 6).Individuals aged over 45 years were 3.53 times more likely to undergo prostate cancer screening compared to those under 45 years (AOR = 3.53, 95% CI: 1.69–5.46)(Fig. 7). Patients who had regular check-ups were 3.65 times more likely to undergo prostate cancer screening compared to those without regular check-ups (AOR = 3.65, 95% CI: 1.09–6.20) (Fig. 8).
Fig. 6.
Forest plot on the association between awareness of prostate cancer screening and prostate cancer screening among cancer patients in Ethiopia: a systematic review and meta-analysis
Fig. 7.
Forest plot on the association between individuals aged over 45 years and prostate cancer screening among cancer patients in Ethiopia: a systematic review and meta-analysis
Fig. 8.
Forest plot on the association between having regular check-ups and prostate cancer screening among cancer patients in Ethiopia: a systematic review and meta-analysis
This systematic review and meta-analysis found that participants with a monthly average income greater than 5000 ETB were 3.8 times more likely to have good awareness compared to those with a lower monthly income (AOR = 3.80, 95% CI: 2.28–5.31) (Fig. 9). According to this systematic review and meta-analysis, a strong association was found between family history of prostate cancer and screening practice, with participants who had a family history being 3.87 times more likely to undergo screening compared to those without (AOR = 3.87, 95% CI: 2.30–5.45) (Fig. 10).
Fig. 9.
Forest plot on the association between Average income >5000 ETB and prostate cancer screening among cancer patients in Ethiopia: a systematic review and meta-analysis
Fig. 10.
Forest plot on the association between family history of prostate cancer and prostate cancer screening among cancer patients in Ethiopia: a systematic review and meta-analysis
Patients who ever heard about prostate cancer had 3.15 times greater odds of cancer screening (AOR = 3.15, 95% CI: 1.43–4.88) compared to those with no information about prostate cancer (Fig. 11).
Fig. 11.
Forest plot on the association between ever heard about prostate cancer and prostate cancer screening among cancer patients in Ethiopia: a systematic review and meta-analysis
Discussion
This systematic review and meta-analysis revealed that the pooled prevalence of prostate cancer screening among Ethiopian men is 30.37% (95% CI: 20.49–40.25%), indicating that screening uptake remains low despite moderate awareness of the disease. Subgroup analysis highlighted substantial geographic variation, with the highest screening prevalence observed in Wolaita Sodo (63.08%) and Amhara region (47.97%), while central Ethiopia reported the lowest prevalence (7.19%) [15, 20, 29]. These disparities likely reflect differences in healthcare access, regional infrastructure, and socio-cultural factors that influence health-seeking behavior.
Several individual and socio-demographic factors were consistently associated with increased prostate cancer screening. Awareness of prostate cancer was a strong predictor, with men who were knowledgeable about the disease being 3.36 times more likely to undergo screening than those with poor awareness [15]. Age also played a significant role, as men over 45 years had 3.53 times higher odds of being screened compared to younger men [21]. Regular engagement with healthcare services was another important facilitator, with patients attending routine check-ups showing 3.65 times greater likelihood of screening [30].
Socioeconomic factors were also influential. Men with a monthly income above 5000 were 3.80 times more likely to have good awareness, and those with a family history of prostate cancer were 3.87 times more likely to be screened, underscoring the importance of perceived personal risk and financial resources in motivating preventive behaviors [14, 24, 29]. Exposure to information about prostate cancer, such as having ever heard about the disease, increased screening odds by 3.15 times, highlighting the role of health education and communication.
Overall, these findings suggest that both knowledge- and behavior-related factors, as well as socio-demographic determinants, significantly influence prostate cancer screening uptake in Ethiopia [14, 31, 32]. The observed low prevalence of cancer screening, combined with regional disparities, emphasizes the urgent need for tailored public health interventions that enhance awareness, improve access to screening services, and target high-risk groups to reduce the burden of prostate cancer in the country.
This systematic review and meta-analysis revealed that while awareness of prostate cancer among Ethiopian men is moderately high ranging from 65% to 74% the actual uptake of screening remains critically low, often below 10% [1, 5, 9, 12]. This significant gap between knowledge and practice indicates that awareness alone does not translate into preventive health actions. The strongest predictors of screening uptake were related to prior exposure to information about prostate cancer, a family history of the disease, and social exposure through knowing someone who had been screened. These factors highlight the importance of information dissemination and social influence in motivating men to undergo screening [1–3].
Socioeconomic status and access to healthcare services also played a significant role in screening behavior. Men with higher education levels, better income, and urban residency were more likely to participate in screening programs, reflecting disparities in healthcare access between urban and rural populations [9, 17]. Furthermore, effective communication from healthcare providers emerged as a critical facilitator for screening, suggesting that provider engagement can strongly influence men’s health-seeking behaviors.
Despite these findings, screening rates remain alarmingly low, which may be attributed to multiple barriers including limited healthcare infrastructure, cultural beliefs, stigma, and lack of organized national screening programs. Rural areas face particular challenges due to poor access to health facilities and information. These systemic issues underscore the need for comprehensive public health interventions that go beyond raising awareness to address structural and cultural barriers to screening.
To bridge the gap between awareness and practice, strategies must integrate community education, strengthen healthcare provider training, and expand accessible screening services, especially in underserved regions. Enhancing social support networks and utilizing community leaders may also improve acceptance and uptake of prostate cancer screening. Ultimately, a multifaceted approach is essential to increase early detection, improve treatment outcomes, and reduce prostate cancer mortality in Ethiopia.
Strengths and limitations
Prostate cancer screening in Ethiopia faces several barriers similar to those observed across Sub-Saharan Africa, including low awareness, cultural and religious beliefs, fear of diagnosis, stigma, limited access to health services, and mistrust of the healthcare system. Addressing these challenges requires community-based education programs that leverage family and peer influence, coupled with proactive engagement of healthcare providers to promote screening uptake.
This systematic review and meta-analysis also has certain limitations. The analysis included a limited number of studies conducted in only a few regions of Ethiopia—namely Addis Ababa, Southern, Central, and Amhara—which constrains the national representativeness of the findings. Although subgroup analysis was conducted, the substantial regional variations in prostate cancer screening prevalence could not be fully explained, and high heterogeneity (I² = 96.7%) persisted. Furthermore, most included studies primarily focused on factors such as awareness and income, with limited exploration of other influential barriers such as cultural and religious beliefs, fear of diagnosis, stigma, and the absence of organized national screening programs.
Further research using nationally representative samples and incorporating a broader examination of contextual, cultural, and behavioral factors is warranted. Longitudinal and interventional studies are particularly recommended to evaluate the effectiveness of community-based and provider-led initiatives and to inform the design of culturally sensitive strategies that can improve screening uptake and reduce prostate cancer morbidity and mortality in Ethiopia and similar settings.
Conclusion
Prostate cancer screening in Ethiopia remains low, with significant regional disparities. Screening uptake is higher among older men, those with higher income, prior awareness, a family history of prostate cancer, or regular health checkups. These findings highlight the urgent need for region-specific interventions, such as educational programs and improved access to screening services, to promote early detection. Additionally, nationwide, longitudinal, and mixed-method studies are needed to assess the effectiveness of interventions and to explore behavioral, cultural, and systemic factors influencing screening practices.
Acknowledgements
Not applicable.
Disclosure
The authors declare that they have no conflicts of interest for this work.
Abbreviations
- CDC
Centers for disease control and prevention
- NCDs
Non-communicable diseases
- WHO
World Health Organization
- ISO
International Organization for Standardization
- JCAHO
Joint Commission on Accreditation of Healthcare Organizations
- JIB
African Joanna Briggs Institute
- QMS
Quality Management System
- PRISMA-P
Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols
Authors’ contributions
TLA, KAA and MGF are involved in the design, selection of articles, data extraction, statistical analysis, manuscript editing, and writing, and take responsibility and be accountable for the contents of the article. All authors read and approved the final draft of the manuscript.
Funding
There is no funding to report.
Data availability
The datasets supporting the conclusion of this article are included in the article.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets supporting the conclusion of this article are included in the article.