Background
Prostate cancer is a major public health problem globally and remains the leading malignancy affecting men in Zimbabwe. Its rising burden has been driven by demographic transitions, limited awareness, and constrained diagnostic capacity. Zimbabwe continues to report high incidence and mortality, with prostate cancer contributing significantly to national cancer morbidity. Despite global advances in screening and early detection, local epidemiological data remain inadequate, especially regarding prevalence, risk factors and comorbidities among men presenting to tertiary facilities. This study addressed this gap by investigating the prevalence and determinants of prostatic adenocarcinoma at the largest referral hospital in Zimbabwe during January–December 2024.

Objectives
The study aimed to: (1) determine the prevalence of prostate cancer among cancer patients admitted at PGH in 2024; (2) estimate the stratified prevalence of histological subtypes; (3) identify comorbidities associated with prostate cancer; (4) evaluate the association between HIV and prostatic adenocarcinoma; and (5) assess socio-demographic factors influencing prostate cancer risk.

Methods
The study was conducted at the Parirenyatwa Group of Hospitals (PGH) in Harare. A cross-sectional study design was employed. The study population comprised all cancer cases diagnosed at PGH in 2024, from which 385 men aged 40–75 years were sampled. Data collection included PSA testing, digital rectal examination, histopathology, and structured questionnaires capturing socio-demographic characteristics, lifestyle factors, comorbidity history and family history of prostate cancer. Descriptive statistics and chi-square tests were used to evaluate prevalence patterns and associations, while odds ratios quantified risk. Ethical approval was obtained from the Africa University Research Ethics Committee (AUREC).

Results
Of the 385 men assessed, 125 were diagnosed with prostatic adenocarcinoma, yielding a prevalence of 32.43%. Prevalence increased markedly with age, peaking among men aged 60–69 years (13.46%). Geographical variations were observed, with Mashonaland Central province recording the highest adenocarcinoma burden (12.25%). Histopathologically, T2a lesions were most common (24.0%). Comorbidities were present in 21.77% of prostate cancer patients, with HIV being the most frequent (9.44%), followed by syphilis, HPV, and TB. HIV was significantly associated with prostate cancer across all age groups (p < 0.05), with the highest odds observed in men aged 60–69 years (OR = 1.5). Family history was also notable: 13.17% of cases reported a positive familial background, underscoring genetic predisposition as a major factor.

Conclusions/Implications
The study reveals a high prevalence of prostatic adenocarcinoma among men aged 40–75 years at Zimbabwe’s largest referral hospital, with age, family history, HIV status, and geographical location emerging as key determinants. The strong association between HIV and prostate cancer highlights the need for integrating prostate cancer screening into HIV care programs. Public health efforts should prioritize awareness, early screening, and targeted interventions for high-risk groups. Strengthening cancer surveillance and expanding access to diagnostic services are critical for reducing the burden and improving outcomes for prostate cancer in Zimbabwe.