Jacques Mbalirende, 77, a father of four from Kigali’s suburb of Nyamirambo, is a prostate cancer survivor who was diagnosed in 2017 after a routine checkup led to further testing. ALSO READ: Men over 45: ‘Even if you feel fine, get screened since early prostate cancer detection can save your life’ – medic Doctors initially carried out a prostate-specific antigen (PSA) blood test, which measures a protein produced by the prostate gland. The results led to his referral to King Faisal Hospital for further examinations. Initial tests did not detect cancer, but a subsequent biopsy—a procedure in which a small sample of prostate tissue is examined under a microscope—confirmed the presence of prostate cancer. ALSO READ: Prostate cancer, the slow but steady killer of men “Doctors recommended a surgery to remove the entire prostate gland and some surrounding tissue to eliminate the cancer. At the time, a visiting urology specialist from the United States was working with local doctors, and the team jointly managed the operation,” Mbalirende said. He did not experience pain or other symptoms, apart from difficulty urinating, which is common in prostate disease. After the surgery, he was prescribed medication to improve urinary flow, which helped relieve the condition. “Before the surgery, I had problems urinating. I felt that my bladder was not empty. After the surgery, the medicine helped me,” he said. ‘Late diagnosis is one of the biggest challenges’ Mbalirende is now cancer-free but continues to attend checkups every six months to ensure the disease does not return. He encourages men, especially older ones, to go for early screening because prostate cancer often develops without noticeable symptoms and can be treated successfully if detected early. Prostate cancer is the most common cancer among men in Rwanda, followed by penile, kidney, bladder, and testicular cancers—collectively known as urogenital cancers—according to Dr. Edouard Ngendahayo, a consultant urologist at King Faisal Hospital and chairperson of Rwanda Urological Association (RUA). Urogenital cancers affect the urinary system and the genital (reproductive) organs. In an interview with The New Times during a Rwanda Urological Association symposium held in Kigali on February 6, Dr. Ngendahayo said that many patients also suffer from urethral obstruction, a condition that makes it difficult or impossible to pass urine. “We have hundreds of patients waiting for surgery to correct this problem, and late diagnosis is one of the biggest challenges. Both health workers and the public fail to recognise early warning signs. Some clinicians do not know these diseases well enough, and patients end up seeking care when the cancer is already advanced,” he said. Ngendahayo explained that Rwanda is struggling to cope with a heavy burden of urological diseases and cancers due to a limited specialist workforce. “We are only 15 urologists serving a population of about 14 million people. We handle everything, including congenital malformations, infections, and cancers of the urinary and reproductive systems. The demand is beyond our capacity.” To address the shortage of specialists, the association is promoting community outreach programmes focused on early detection. He explained that the initiative aims to take services closer to patients by providing education, basic examinations, and sample collection, while referring only those who require specialised care. “In 2022, we ran a pilot programme in which urologists visited four provincial hospitals to raise awareness about prostate cancer and conduct examinations. In one week, we reached more than 1,000 people, which showed us what can be achieved with the right support.” Funding and logistics remain major challenges, as deploying teams of eight to 10 specialists to district hospitals for several days to consult, treat patients, and collect data requires significant resources. “Early detection can save lives, particularly for visible cancers such as penile cancer. When a lesion is found early, it can be removed before the disease spreads. We need to change how we operate. Instead of waiting for patients to reach referral hospitals, we should take services to the community,” Ngendahayo said. With strong partnerships and proper planning, many cancers can be identified and treated in time, he said. What are the common cancers in men? Prostate cancer accounts for about 80 percent of all cancers of the urinary and reproductive systems in Rwanda and is now the third most common cancer in the country, after cervical and breast cancer, according to Dr. Theoneste Maniragaba, the Director of the Cancer Programme at Rwanda Biomedical Centre (RBC). Dr. Maniragaba said that prostate, cervical, and breast cancers together make up more than 60 percent of cases recorded in the national cancer registry, underscoring the need to prioritise prevention and early treatment. Screening is important even for men who feel healthy, he said, advising men to begin testing at 40, as prostate cancer tends to appear earlier in Black African populations. Some men ignore warning signs such as difficulty urinating or sexual problems, he noted, assuming they will heal on their own, yet these symptoms can indicate prostate cancer. “Rwanda has recently expanded its cancer benefit package under the community-based health insurance scheme (Mutuelle de Santé) to cover screening and treatment for cervical, breast, and prostate cancers. This includes prostate-specific antigen testing and clinical examinations,” Maniragaba said. Rwanda needs skilled specialists in surgery, radiation oncology, and medical oncology, supported by well-equipped hospital infrastructure, he admitted. Adequately trained teams and proper operating theatres are essential for patients to receive quality care. Prostate cancer screening services are available at referral hospitals including Rwanda Military Hospital, the University Teaching Hospital of Kigali (CHUK), the University Teaching Hospital of Butare (CHUB), and Butaro Hospital.
