Patterns of Presentation of Prostate Cancer Among Patients at Port Sudan Oncology Center, Red Sea State, Sudan: A Retrospective CrossSectional study (2022-2026)

The Silent Alarm and the Overgrown Garden

Imagine your body is a massive, bustling city. Most of the time, the construction crews (your cells) follow the blueprints perfectly, building new structures and tearing down old ones without causing a fuss. But sometimes, a few workers get confused. They stop listening to the "stop" signals and start building non-stop, piling up bricks where they shouldn't. This is cancer. It's not a sudden explosion; it's a slow, creeping construction project that can eventually block the roads and crush the neighborhoods around it.

In the city of the male body, there is a small, walnut-sized gland called the prostate. It sits right below the bladder, acting like a gatekeeper for the plumbing system. Its main job is to produce a special fluid that helps carry sperm. To keep an eye on this gland, doctors use a chemical "smoke alarm" called PSA (Prostate-Specific Antigen). Normally, a tiny bit of this smoke drifts into the blood. But if the gland gets clogged or starts growing wildly, the smoke alarm goes off, and the levels in the blood shoot up. Another tool doctors use is a "danger rating" called the Gleason score, which grades how messy and aggressive the construction crew looks under a microscope. The higher the score, the faster the building is expanding and the more likely it is to break out of the neighborhood.

Why does this matter? Because catching this construction crew early is like stopping a fire before it burns down the whole block. If you catch it while it's just a small pile of bricks, you can remove it easily. But if you wait too long, it spreads to the bones and other organs, making it much harder to fix. This story is about what happens when that alarm is ignored for too long, specifically in a region where the fire department hasn't been checking the smoke detectors often enough.

---

The Story from Port Sudan: When the Smoke Alarm Screams

A team of researchers from Eastern Sudan University decided to investigate a very serious situation at the Port Sudan Oncology Center. They looked back at the medical records of 129 men who were diagnosed with prostate cancer between 2022 and 2026. Their goal was to figure out: "When these men finally walked through the hospital doors, what did their bodies look like? Had the cancer been growing quietly for years, or did they just show up late?"

The results they found were like walking into a house where the fire had already burned through the roof.

The Age of the Patients
First, the researchers noticed that this wasn't a disease of the young. The average age of the men in this group was nearly 70 years old (specifically 69.9). In fact, more than 8 out of 10 men were 60 or older. Only a tiny handful, about 3%, were under 50. It seems that in this part of Sudan, the cancer mostly waits until the men are well into their senior years before it makes its presence known.

The Symptoms: The Plumbing is Clogged
When these men finally sought help, they weren't walking in with a vague feeling of "maybe something is wrong." They were in distress. The most common complaint, affecting half of the patients, was trouble with their plumbing—things like needing to pee constantly or having a weak stream. These are called Lower Urinary Tract Symptoms (LUTS).

But it got worse. About 35% of the men couldn't pee at all; their systems were completely blocked (urinary retention). Another 28% had back pain. In the world of prostate cancer, back pain is a huge red flag. It usually means the "construction crew" has stopped building in the prostate and has started moving to the bones, specifically the spine.

The Smoke Alarm: A Sky-High PSA
Here is where the numbers get truly alarming. The researchers measured the PSA levels in the blood of 106 of these men. The average level was a staggering 194.95 ng/mL.

To put that in perspective, a normal, healthy prostate usually keeps this number below 4 ng/mL. These men had levels nearly 49 times higher than the normal limit. Even more shocking, more than one-third of the men had levels above 100 ng/mL. In medical terms, a PSA that high strongly indicates advanced disease. It's as if the smoke alarm wasn't just ringing; it was screaming so loud it shattered the glass.

The Danger Rating: High-Grade Trouble
The doctors also looked at the tissue samples under a microscope to give the cancer a "danger rating," known as the Gleason score. A low score (like 6) means the cancer is slow and indolent. A high score (8 to 10) means it is aggressive and fast.
In this group, the average score was 7.88, which is quite high. Even more concerning, 59.3% of the men had the highest danger rating (8 to 10). This means the majority of these cancers were the aggressive, fast-moving kind that needs immediate, heavy-duty treatment.

The Stage: It's Everywhere
Perhaps the most striking finding was about the "stage" of the disease. The researchers could only find complete staging information for 44 of the patients (many records were missing). But for every single one of those 44 men, the cancer was Stage IV.

Stage IV is the final stage. It means the cancer has spread to distant parts of the body, like the bones. The paper notes that all the patients with available data were at this advanced stage. While we cannot say for certain about the men with missing records, the fact that every single patient with known data presented at this late stage suggests that in this region, catching the disease early is extremely rare. By the time they are diagnosed, the "fire" has likely already spread to the whole building.

The Long Wait: Why Did They Wait?
The researchers also asked, "How long were these men suffering before they came to the hospital?" For the 70 men who had this information recorded, the average wait was 9.3 months.
More than half of them had been dealing with symptoms for between 3 and 12 months. Only a small fraction (about 16%) went to the doctor within the first three months of feeling sick. This long delay is a major clue. It suggests that many men either didn't realize their symptoms were serious, couldn't afford to get checked, or didn't have access to a doctor who could run the PSA test early on.

What the Paper Says (and Doesn't Say)
The authors are very clear about what they found and what they don't know. They found a strong pattern of late detection, high PSA levels, and aggressive cancer. They explicitly state that this is a "retrospective" study, meaning they looked at old records, so they can't prove why the men waited so long, only that they did. They also admit that because so many records were missing (especially regarding the exact stage for everyone), they can't be 100% sure about the exact numbers for the whole population, but the trend is undeniable.

They do not claim that this is the only way prostate cancer behaves everywhere, but they do argue that in Port Sudan, the current system is failing to catch the disease early. They suggest that the lack of screening programs and public awareness is the main reason these men arrive at the hospital with advanced, difficult-to-treat cancer.

The Bottom Line
This study paints a vivid picture of a medical emergency in the Red Sea State. The prostate cancer patients there are arriving at the hospital with their "smoke alarms" screaming at levels nearly 50 times the normal limit, their cancer rated as highly aggressive, and their disease already spread to their bones. The average man in this group waited nearly a year after symptoms started before getting help. The researchers conclude that without a major change—like starting regular screening programs and teaching men to recognize the early signs of trouble—this pattern of late, dangerous diagnosis will continue. The fire is being detected only after the house is already burning.