In 2020, Alexandre Mugwaneza, 69, visited his wife’s paternal cousin, who was battling prostate cancer. The image of a once-active man now frail and bedridden stayed with him. Though Mugwaneza felt fine, that visit had unsettled him. It made him think, seriously, for the first time, about the importance of early screening.

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A few months later, in July, he was diagnosed with malaria. While receiving treatment, his thoughts returned to his wife’s cousin. Even though Mugwaneza had no symptoms, he requested for a prostate-specific antigen (PSA) test just to be sure. The results were shocking. His PSA level was 105 Nanograms per millilitre (ng/mL), far above the normal range.

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He was immediately referred to a urologist.

Further tests, including a biopsy, confirmed that he had stage four prostate cancer.

Stage four prostate cancer, also known as metastatic prostate cancer, is the most advanced stage, where the cancer has spread beyond the prostate gland to other parts of the body.

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This stage is characterized by cancer cells breaking away and traveling to distant sites, like bones, liver, or lungs, through the lymphatic system or bloodstream. While stage four prostate cancer is not curable, reports indicate that treatments like hormone therapy, chemotherapy, and targeted therapies can help manage the disease and improve quality of life.

All of his 12 tissue samples tested positive, and the cancer had spread to his lymph nodes. It was a heavy blow. But medics assured him the disease had not spread to distant organs. It was still treatable.

He was referred to a doctor at Rwanda Cancer Centre (RCC) at Rwanda Military Referral and Teaching Hospital, in Kanombe, where he began treatment in January 2021. First came hormonal therapy to slow the cancer’s growth, then a 37-day course of radiation. The side effects were minimal but the experience was demanding. Mugwaneza pushed through with resilience. He credits RCC staff for their care, clarity, and support throughout the process. After treatment, he continued receiving hormonal therapy every three months to keep the cancer in control.

He was grateful that such high-quality treatment was available in Rwanda, without the need to travel abroad.

In 2023, his PSA levels began to rise again. Concerned, his doctors ordered a positron emission tomography (PET) scan, which he underwent in India. A positron emission tomography scan is an imaging test that helps reveal the metabolic or biochemical function of the body's tissues and organs.

The results brought relief. There were no signs of cancer.

Today, he is cancer-free but continues his hormonal therapy as a preventive measure and remains committed to regular check-ups and is more mindful than ever about his health. Looking back, he believes that asking for that PSA test when nothing felt wrong saved his life.

Mugwaneza urges other men, especially those over 50, to prioritize their health.

"Even if you feel fine, get screened, as early detection and timely treatment can lead to a positive outcome.”

Prostate cancer was the third most common cancer in Rwanda in 2023, with 516 cases recorded, following breast cancer with 739 cases, and cervical cancer with 636 cases, according to data from Rwanda Biomedical Centre (RBC).

The disease primarily affects men over the age of 50, but recent findings indicate that younger men, starting from 45, are also at risk.

Many of these cases are diagnosed at advanced stages, making treatment more complex.

Dr. Theoneste Maniragaba, the Director of the Cancer Programme at RBC, noted that the underlying causes of prostate cancer in younger men remain unclear.

While age is a known risk factor, studies suggest that genetic predisposition may play a role. Research indicates that certain genetic mutations found in black men may contribute to early-onset prostate cancer.

Despite the increasing cases, awareness about the importance of early screening remains low as people do not seek medical attention unless they experience symptoms. It’s not a matter of education but culture. Even among intellectuals, many do not see the need for check-ups when they feel fine,” Dr. Maniragaba said, stressing the need to shift societal attitudes toward regular health check-ups to ensure early detection.

Screening for prostate cancer starts with a simple blood test measuring Prostate-Specific Antigen (PSA). A normal PSA range is between zero and four, but levels can rise due to cancer or other prostate conditions.

If PSA levels are elevated, further tests such as MRIs, digital rectal examinations, or ultrasounds can be conducted to confirm the diagnosis.

Dr. Maniragaba recommends that men between 45 and 50 years should undergo routine screenings, noting that prostate cancer develops slowly, often taking years before symptoms appear.

"If a patient is diagnosed at an advanced stage, they could have had the disease for five or 10 years already. Screening at the age of 45 helps detect it early, preventing complications later.”

The medic added that the cancer is usually localized and still small when detected early. In such cases, skilled surgeons can remove the prostate, and thereby pave way for a full recovery. Many patients have been successfully treated because they sought medical care in time.

For early screening, the medic advises men to visit medical facilities like King Faisal Hospital-Kigali, and any of the country’s teaching hospitals such as the University Teaching Hospital of Kigali (CHUK), Rwanda Military Referral and Teaching Hospital, and Butaro Cancer Centre in Burera District.

Symptoms

According to Mayo Clinic, a private American academic medical center focused on integrated healthcare, education, and research, prostate cancer may not cause symptoms at first.

Most prostate cancers are found at an early stage. This means that the cancer is only in the prostate, a small gland that helps make semen found just below the bladder. The prostate is part of the male reproductive system. An early-stage prostate cancer often doesn't cause symptoms.

According to Mayo Clinic, when they happen, early-stage prostate cancer signs and symptoms can include: