Abstract
<title>Abstract</title> <p> <bold>Background</bold> : Prostate cancer (PCa) is a leading cause of cancer-related mortality and a major public health challenge worldwide. With over 1.4 million new cases diagnosed annually, its incidence is notably increasing in low- and middle-income countries. The disease typically affects men older than 65 years and presents a broad spectrum of clinical manifestations, ranging from indolent, asymptomatic tumors to aggressive variants associated with rapid progression and distant metastasis. <bold>Methods</bold> : A descriptive cross-sectional retrospective study was conducted to analyze the presentation patterns of PCa among patients in the Red Sea State, Sudan (2022–2026). Data were extracted from the medical records of 129 patients at the Port Sudan Oncology Center, which serves as the primary and sole oncology facility in this region. <bold>Results</bold> : The cohort's mean age was 69.9 years, with 80.6% of patients aged $\ge$ 60 years. Lower urinary tract symptoms (LUTS) were the most frequent presenting complaint (50%), followed by urinary retention (34.8%) and back pain (27.7%). The mean serum PSA level was exceptionally high at 194.95 ng/mL, with more than one-third of the cohort exceeding 100 ng/mL, strongly indicating advanced disease. Histopathologically, adenocarcinoma was the predominant type (99.2%), and 59.3% of patients had high-grade tumors (Gleason score 8–10). Strikingly, all patients with available staging data were diagnosed with Stage IV disease. A diagnostic delay was evident, as most patients experienced symptoms for 3–12 months prior to formal diagnosis. <bold>Conclusion</bold> : PCa in the Red Sea State is predominantly diagnosed at an advanced stage, characterized by markedly elevated PSA levels and high-grade tumors. Delayed presentation remains a critical challenge, underscoring the urgent need for increased health awareness, early detection strategies, and effective screening programs to improve clinical outcomes. </p>