Too Far, Too Late:

For almost a year, Elly Kworoba lived with symptoms that seemed like the Urinary Tract Infections (UTI) which would not completely heal despite seeking medical interventions.

For the most part, his signs would easily be associated to ageing or an ordinary urinary problem until a doctor with knowledge of his family history recommended an advanced checkup.

“I started getting the symptoms in 2019, and I was diagnosed at the end of September 2020. So, I lived with it for almost a year,” he says.

There was no moment that immediately told him he had cancer of the prostate. The signs could easily have been associated with ageing or an ordinary urinary problem.

Cancer, Kworoba says, does not necessarily announce itself “like a cough.”

Kworoba is one of the lucky survivors of the disease that kills more than 1,300 men in Uganda each year, according to data from the International Agency for Research on Cancer.

According to officials at Uganda cancer institute, cancer deaths in Uganda are attributed largely to the late diagnosis. Dr. Fred Okuku, a senior oncologist at UCI says that a vast majority of patients present at advanced stages (such as Stage 4), which drastically lowers survival and cure rates.

“Majority of our people come to seek diagnosis and treatment late,” he says.

For millions of Ugandans, the nearest point of contact with the public health system is not the Uganda Cancer Institute in Kampala or a regional referral hospital. It is a Health Centre III or Health Centre IV.

Uganda’s health-service structure reveals a critical gap between where many men live and where one of the key tests used in prostate cancer assessment is expected to be available.

The Ministry of Health’s 2024 National Essential Health Care Package provides for annual prostate-specific antigen, or PSA, testing for men aged 40 years and above. But the package places the service at hospital level.

Health Centre IIIs and IVs can provide rectal examinations for prostate conditions, but routine PSA testing is not designated at those levels.

For a man in rural Uganda, early detection can therefore begin with a journey.

According to a study published in African Health Sciences in 2024, the median time between a patient first recognizing symptoms and receiving a diagnosis was 12 months. About 76 percent were diagnosed more than four months after first experiencing symptoms.

This is exactly what Kworoba went through. He started treating symptons in 2019, and got a diagnosis in 2021.

“There should be a mechanism where if you are over 50 years, you can take up the diagnosis at least once every year,” Kworoba says. 

Uganda has built one of the region’s most recognised specialist cancer institutions at the Uganda Cancer Institute.

But early detection cannot depend primarily on what happens at a specialist institution, according to Dr. Wilberforce Kabweru, a consultant surgeon at Mulago National Referral Hospital.

“Let us take services to the common man, putting the right structures and personnel to see those patients,” he says.

Uganda struggles with a funding problem for its public health infrastructure. Much as the Uganda Cancer Institute’s allocation increased considerably in the 2025/26 financial year to approximately Shs243.4 billion, there are still resource gaps in cancer treatment and management.

The rising cases of prostate cancer therefore raises another question about how cancer resources are distributed along the patient’s journey.

A recent budget review reveals that regional cancer centers have a recurrent allocation of approximately Shs935 million, while clinical oncology received about Shs7.14 billion and clinical support services Shs23.87 billion.

Uganda needs radiotherapy machines, operating theatres, laboratories, imaging equipment and regional cancer centres.

Yet a functioning early-detection system requires these health workers to recognize possible prostate disease, understand which men may require screening, counsel them and move suspected cases efficiently through the referral system.

However, a Health Centre III may physically exist in a community but may lack the capacity to handle the cases.

On a normal day, care workers simultaneously handle malaria, maternal health, immunization, HIV, childhood illnesses and emergencies, preventive cancer services must compete for the same personnel and resources.

Uganda’s prostate cancer challenge therefore exists at two ends of the health system.

At one end are communities where routine screening remains limited and primary health facilities operate under staffing, diagnostic and financing constraints.

A referral system measured in kilometres

A patient may require specialist clinical assessment, imaging, biopsy and pathological examination before a definitive diagnosis can be made.

Those services become increasingly specialised as the patient moves through the referral system.

That creates another danger: every additional referral can mean transport costs, accommodation expenses, lost working days and waiting time.

Yet patients may need repeated appointments for radiotherapy, chemotherapy, hormonal treatment, investigations and follow-up.

Government’s Public Investment Plan says the regional cancer centres being developed in Arua, Mbale and Mbarara are intended to increase access to cancer care and bring services closer to the population.

Other regional cancer services are also being developed as Uganda tries to reduce dependence on Kampala.

Parliament, however, has previously questioned the financing required to make decentralisation work.

During scrutiny of the 2024/25 health budget, Parliament’s Health Committee reported that fully operationalising the Mbarara and Gulu cancer centres required approximately Shs15 billion, but only about Shs4.1 billion had been provided at that stage, leaving a gap of approximately Shs10.9 billion.

The committee also identified a larger financing gap affecting the planned regional cancer centres in Arua, Mbale and Mbarara at the time.

Government allocations for regional cancer infrastructure have since increased substantially.

The earlier UCI cohort found bone metastases among 73 percent of patients with documented metastatic sites and spinal cord compression among almost one-third of the men studied.

For Kworoba, surviving prostate cancer has transformed his experience into a warning to other men.

He wants men, particularly those over 50, to stop waiting for severe symptoms before thinking about their prostate health.