Immunophenotyping and Molecular Patterns of Prostate Cancer in East Africa: Diagnostic and Prognostic Implications-A Systematic Review.

Prostate cancer disproportionately affects Sub-Saharan African men, who often present with aggressive, late-stage disease. This systematic review synthesizes contemporary evidence on the immunophenotyping and molecular patterns of prostate cancer in East Africa to inform regional screening and precision oncology strategies. Following PRISMA 2020 guidelines, a systematic search was conducted across PubMed, Scopus, and Web of Science for studies published between January 1, 2011 and December 31, 2025. The review protocol was preregistered in Open Science Framework (OSF Registration ID: https://doi.org/10.17605/OSF.IO/RJZFT). Eligible studies were original research articles involving histologically confirmed prostate cancer in East African countries as classified by the United Nations Geoscheme for Africa (Eastern Africa subregion), reporting on immunohistochemical markers or genomic alterations. Preclinical studies, in vitro/in silico studies, case reports, editorials, and meeting abstracts were excluded. Quality was appraised using Joanna Briggs Institute Critical Appraisal Tools. Seven original studies involving participants from Uganda, Sudan, Kenya, and Rwanda were included. Study designs comprised 5 analytical cross-sectional studies and 2 case-control studies. Patient ages ranged from 45 to 107 years (mean ∼70-74 years across cohorts). Dominant histopathological subtype was high-grade acinar prostatic adenocarcinoma. Findings reveal mean prostate-specific antigen levels reaching 434.06 ng/mL and high-grade malignancies (Gleason Score ≥ 8) in up to 82.4% of cases. Key biomarkers identified include Cyclin D1 expression (98.3%), ERG positivity (75.4%), and pathogenic variants at the 8q24 locus (rs72725854). Loss of BRCA1/2 was noted in high-grade tumors. All included studies demonstrated a low risk of bias, though confounding management remains a recurring methodological weakness. East African prostate cancer is defined by an aggressive molecular profile and systemic diagnostic delays. The identification of population-specific genetic drivers necessitates a shift from Western-derived risk models toward decolonized precision oncology and decentralized diagnostic infrastructure to improve early detection and patient outcomes.