Possible association and co-existence of schistosome infection and prostate cancer: A systematic review

Emilia T. Choto, Takafira Mduluza, Elopy N. Sibanda, Francisca Mutapi, Moses J. Chimbari


Male genital schistosomiasis (MGS) may result in eggs lodged in the prostate causing persistent inflammation that may play a major role in prostate carcinogenesis. Globally, prostate cancer (PCa) is one of the most common cancers and the global distribution of PCa overlaps with that of schistosomiasis infections, suggesting a probable causal relationship. Objectives of this review were to assess evidence of co-existence of schistosomiasis and PCa and possible causal association between the two diseases. Relevant literature published between 1950 and 2019 yielded 20 publications on schistosomiasis and PCa co-existence. Schistosoma (S.) haematobium and S. mansoni were associated with MGS manifestation and mostly prostate adenocarcinoma diagnosis. Effects of prostatic MGS infection progressed over time with high Schistosoma egg burden thought to contribute to the development of PCa. Causal association and mechanistic pathways of MGS on PCa development and the role of Schistosoma eggs on the development of PCa remains unestablished. (Afr J Reprod Health 2020; 24[4]: 185-197).

Full Text:



World Health Organization. Neglected tropical diseases.

WHO 2018; http://www.who.int/neglected_diseases/diseases/summary/en/ (accessed 2 Nov 2018).

Colley DC and Secor WE. Immunology of Human

Schistosomiasis. Parasite Immunol. 2014; 36(8): 347–57.

McManus DP, Bergquist R, Cai P, Ranasinghe S, Tebeje

BM and You H. Schistosomiasis-from immunopathology to vaccines. Semin Immunopathol. 2020; 42(3): 355–71.

Rollinson D. A wake up call for urinary schistosomiasis:

reconciling research effort with public health importance. Parasitology 2009; 136(12): 1593–1610.

Elbaz T and Esmat G. Hepatic and Intestinal

Schistosomiasis: Review. J Adv Res. 2001; 4(5): 445–52.

McManus DP, Dunne DW, Sacko M, Utzinger J,

Vennervald BJ and Zhou XN. Schistosomiasis. Nat Rev Dis Primers. 2018; 4(1):13.

Gryseels B. Schistosomiasis. Infect Dis Clin North Am.

; 26(2): 3839–7.

World Health Organisation. Epidemiology table of

schistosomiasis current estimated total number of individuals with morbidity and mortality due to Schistosomiasis haematobium and S. mansoni infection in Sub-Saharan Africa. WHO 2019; http://www.who.int/schistosomiasis/epidemiology/table/en/ (accessed 13 May 2019).

Utzinger J, Raso G, Brooker S, De Savigny D, Tanner

M, Ornbjerg N, Singer BH and N'goran EK. Schistosomiasis and neglected tropical diseases:

towards integrated and sustainable control and a word of caution. Parasitol. 2009; 136(13): 1859–74.

Keating JH, Wilson RA and Skelly PJ. No overt cellular

inflammation around intravascular schistosomes in vivo. J Parasitol. 2006; 92(6): 1365–9.

Mbabazi PS, Andan O, Fitzgerald DW, Chitsulo L,

Engels D and Downs JA. Examining the relationship between urogenital schistosomiasis and HIV infection. PLOS Neg Trop D 2011;5: e1396.

Feldmeier H, Leutscher P, Poggensee G and Harms G.

Male genital schistosomiasis and haemospermia. TM &IH.

; 4(12): 791–3.

Leutscher, PD, Pedersen M and Raharisolo C. Increased

prevalence of leukocytes and elevated cytokine levels in semen from Schistosoma haematobium-infected individuals. J Infect Dis. 2005; 191(10): 1637–47

Manasseh AN, Echejoh GO, Tanko MN, Olugbenga O,

Dakum SK and Mandong BM. Prostatic adenocarcinoma co-existing with schistosomiasis: A case report and review of literature. Inter J Med Sci. 2009; 1: 33–7.

Bustinduy AL and King CH. Schistosomiasis, chapter 49

in Farrar J, Hotez P, Junghanssv T, Lalloo D and White N. Manson’s Tropical Diseases, 23rd ed., Elsevier, (in press).

Leutscher P, Ramarokoto CE, Reimert C, Feldmeier H,

Esterre P and Vennervald BJ. Community-based study of genital schistosomiasis in men from Madagascar. Lancet 2000; 8: 358(9198): 117–8.

Perdichizzi A, Nicoletti F, La Vignera S, Barone N,

D’Agata R, Vicari E and Calogero AEE. . Effects of tumour necrosis factor-alpha on human sperm motility and apoptosis. J Clin Immunol 2007; 27(2): 152–62.

Gleason DF and Mellinger GT. Prediction of prognosis

for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol 1974; 111(1): 58–64.

Humphrey PA, Moch H, Cubilla AL, Ulbright TM and

Reuter VE. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs—Part B: Prostate and Bladder Tumours. EAU 2016; 70(1); 106–19.

Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL and

ISUP Grading Committee. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am. J. Surg. Pathol. 2005; 29:1228–42.

National Comprehensive Cancer Networks Organisation

(NCCN). Guidelines for Patients:Prostate Cancer Version 1. NCCN 2016; http://www.NCCN.org/patients (accessed 10 April 2018).

Siegel RL, Miller KD and Jemal A. Cancer Statistics,

CA Cancer J Clin 2018; 68(1):7–30:

Prostate Cancer Foundation of Australia (PCFA).

Understanding Prostate Cancer.PCFA 2014; http://www.pcfa.org.au (accessed 23 May 2018).

Zimbabwe National Cancer Registry (ZNCR). Profile of

Cancer in Zimbabwe 2014. ZNCR 2015; http://www.zimcancerregistry.co.zw/cancer-profile-in-zimbabwe.html (accessed 19 May 2018).

Miah S and Catto J. Benign prostate hyperplasia and

prostate cancer risk. Indian J Urol 2014; 30(2): 214–8.

Mottet N, Bastian PJ, Bastian J, Bellmunt, van def-Berg

RCN, Bolla. M, van-Casteren NJ, Cornfor P, Jonian S, Mason MD, Matveer V, van-der Kwast TH, van-der-Poet, Rouviere O and Weigel T. Guidelines on prostate cancer. Euro. Urol 2015; https://uroweb.org/wp-content/uploads/1607-Prostate-Cancer_LRV3.pdf (accessed 25 May 2018).

Elfaki TEM, Kebayer MHA and Elsayid M. Association

between urinary schistosomiasis and prostate cancer in Al-Shajara area Khartoum, Sudan. IJNRHN 2015; 2(3): 91–7.

PubMed Health. Behind the headlines health news from

NHS choices. Frequent ejaculation may decrease prostate cancer. PubMed Health, 2017; https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2017-07-06-frequent-ejaculation-may-decrease-prostate-cancer-risk/. Posted Jul 2017 (accessed June 2018).

Bashir MN, Ahmad MR and Malik A. Risk factors of

prostate cancer: A case- control study in Faisalabad, Pakistan. Asian Pac J cancer Prev 2014; 15(23): 10237–40.

Huncharek M, Haddock KS, Reid R and Kupelnick B.

Smoking as a risk factor for prostate cancer: a meta-analysis of 24 prospective cohort studies. Am J Public Health 2010; 100(4): 693–701.

Dennis LK and Dawson DV. Meta-analysis of measures

of sexual activity and prostate cancer. Epidemiology 2002; 13(1): 72–9.

Hosseini M, SeyedAlinaghi S, Mahmoudi M and

McFarland W. A case-control study of risk factors for prostate cancer in Iran. Acta Med Iran 2010; 48(1): 61–6.

Parent ME, Desy M and Siemiatycki J. Does exposure to

agricultural chemicals increase the risk of prostate cancer among farmers? Mcgill J Med 2009; 12(1): 70–7.

Balkwill F and Mantovani A. Inflammation and cancer:

Back to Virchow? Lancet 2001; 357(9255): 539–45.

Malik MO, Veress B, Daoud EH and El Hassan AM.

Pattern of bladder cancer in the Sudan and its relation to schistosomiasis: A study of 255 vesical carcinomas. Am J Trop Med Hyg 1975; 78(10-11):219–26.

International Agency for Research on Cancer (IARC).

Schistosomas, liver flukes and helicobacterpylori. IARC working group on the evaluation of carcinogenic risks to humans, Lyon, 7–14 June 1994. IARC Monogr Eval Carcinog Risks Hum 2008; 61:1–241.

Sheweita SA, El-Shahat FG and Bazeed MA. Effects of

Schistosoma haematobium infection on drug-metabolizing enzymes in human bladder cancer tissues. Cancer Lett. 2004; 205(1): 15–21.

Botelho MC, Soares R, Vale N, Ribeiro R, Camilo V,

Almeida R, Medeiros R, Gomes P, Machado JC and da Costa JMC. Schistosoma haematobium: Identification of new estrogenic molecules with estradiol antagonistic activity and ability to inactivate estrogen receptor in mammalian cells. Exp Parasitol 2010; 126(4): 526–35.

Botelho MC, Alves H, Barros A, Rinaldi G, Brindley PJ

and Sousa M. The role of estrogens and estrogen receptor signaling pathways in cancer and infertility: The case of schistosomes. Tre Par 2015; 31(6): 246–50.

Botelho MC, Alves H and Richter J. Estrogen catechols

detection as biomarkers in schistosomiasis induced cancer and infertility. Letters in Drug Design & Discovery 2016; 13(2):1–4.

Rosin MP, Saad el Din Zaki S, Ward AJ and Anwar

WA. Involvement of inflammatory reactions and elevated cell proliferation in the development of bladder cancer in schistosomiasis patients. Mutat Res 1994; 305(2): 283–92.

Salim E, Morimura K, Menesi A, El-Lity M, Fukushima

S and Wanibuchi H. Elevated oxidative stress and DNA damage and repair levels in urinary bladder carcinomas associated with schistosomiasis. Int J Cancer, 2008;123(3): 601–8.

International Agency for Research on Cancer (IARC).

Working Group on the Evaluation of Carcinogenic Risks to Humans, Biological agents, “A review of human carcinogen,” IARC Monographs on the Evaluation of Carcinogenic Risks to Humans 2012; 100: 1–44. Available at https://monographs.iarc.fr/wp-content/uploads/2018/08/14-002.pdf (accessed 12 February 2018).

Al Adnani MS. Schistosomiasis, metaplasia and

squamous cell carcinoma of the prostate: Histogenesis of the squamous cancer cells determined by localization of specific markers. Neoplasma1985; 32: 613–22.

Alexis R and Domingo J. Schistosomiasis and ad¬

enocarcinoma of prostate: A morphologic study. Hum Pathol 1986; 17(7): 757–60.

Tungekar MF and Al Adnani MS. Sarcomas of the

bladder and prostate: The role of immunohistochemistry and ultrastructure in diagnosis. Eur Urol 1986; 12(3): 180–3.

Godec CJ, Grunberger I and Carr GA. Simultaneous

presence of schistosomiasis and advanced cancer in prostate. J Urol 1992; 39(6): 547–9.

Ma TK, and Srigley JR. Adenocarcinoma of prostate and

schistosomiasis: A rare association. Histopathol 1995; 27(2): 187–9.

Cohen RJ, Edgar SG and Cooper K. Schistosomiasis and

prostate cancer. Path 1995; 27(2):115–6.

Basilio-de-Oliveira CA, Aquino A, Simon EF and Eyer-

Silva WA. Concomitant prostatic schistosomiasis and adenocarcinoma: Case report and review. Braz. J Infect Dis 2002; 6(1): 45–9.

Bacelar A, Castro LG, De Queiroz AC and Cafe E.

Association between prostate cancer and schistosomiasis in young patients: A case report and literature review. Braz J Infect Dis 2007; 11(5): 520–22.

Mazigo HD, Zinga M, Heukelbach J and Rambau P.

Case series of adenocarcinoma of the prostate associated with Schistosoma haema¬tobium infection in Tanzania. J Glob Infect Dis 2010; 2(3): 307–9.

Figueiredo JC, Richter J, Borja N, Balaca A, Costa S,

Belo S and Grácio MA. Prostate adenocarcinoma associated with prostatic infection due to Schistosoma haematobium: Case report and systematic review. Parasitol Res 2015; 114(2): 351–8.

El-Hawary AK and Foda AAM. Incidentally detected

schistosomiasis in male genital organs: Case reports and review of literature. Am J Cas Rep 2016; 4(1): 25–30.

Metrogos V, Ramos N, Marialva C and Bastos J. Rare

association between prostate adenocarcinoma and schistosomiasis: A case report. ACTA Urológica Portuguesa 2017; 34(3-4): 41–3.

Peiffer LB, Poynton SL, Ernst SE, Hicks JL, De Marzo

AM and Sfanos KS. Inflammation-associated pathologies in a case of prostate schistosomiasis: Implications for a causal role in prostate carcinogenesis. Prostate 2019; 79(11): 1316–25.

Mukendi AM, Doherty S and Ngobese L.

Schistosomiasis on prostate biopsy, adenocarcinoma on transurethral resection of prostate specimens. Journal of Clinical Urology 2019: p. 2051415819889203.

Lodhia J, Mremi A, Pyuz JJ, Bartholomeo N and

Herman AM. Schistosomiasis and cancer: Experience from a zonal hospital in Tanzania and opportunities for prevention. Journal of Surgical Case Reports. 2020; 5(44): 1–5.

Shamma AH. Schistosomiasis and Cancer in Iraq. Am J

Clin Pathol 1955; 25(11): 1283–4.

Mutengo MM, Mudenda V, Mwansa JC, Kaonga K,

Sianongo S, Wamulume, HI and Shinondo, CJ. Presence of schistosomiasis in genital biopsies from patients at the University Teaching Hospital in Lusaka, Zambia. Med J Zambia 2009; 36(3): 114–18.

Okani C, Akang E and Ogunbiyi O. Incidence of sub-

clinical prostatic disease at autopsy in the University college hospital, Ibadan. Open Access J. Urol. 2013; 3(2): 80–6.

Der EM, Quayson SE, Mensah JE and Tettey Y. Tissue

schistosomiasis in Accra Ghana: A retrospective histopathologic review at the Korle-Bu Teaching Hospital (2004–2011). Pathol Discov 2015; 3(1): 1–6.

Ehsani L and Adeboye OO. Schistosomiasis of the

prostate: A case report. Anal Quant Cytol Histol 2013; 35(3): 178–80.

Bonnefond S, Cnops L, Duvignaud A, Bottieau E,

Pistone T, Clerinx J and Malvy D. Early complicated schistosomiasis in a returning traveller: key contribution of new molecular diagnostic methods [case report]. Inter J Infect Dis 2019;79: 72–4.

Faust EC. An inquiry into the ectopic lesions in

schistosomiasis. Am. J.Trop. Med & Hyg 1948; s1-28:175–99.

Patil PS and Elem B. Schistosomiasis of the Prostate and

the Seminal Vesicles: Observations in Zambia. J Trop Med Hyg 1988; 91(5): 245–58.

Gelfand M, Ross CMD and Blair DM. Schistosomiasis

of the male pelvic organs: Severity of infection as determined by digestion of tissue and histologic methods in 300 Cadavers. Am J Trop Med Hyg 1970; 19(5): 779–84.

Sharma R, Mahore SD, Kolhe H, Patil R, Bathale K and

Wilkinson A. Schistosoma in the prostate: A case report. Int J of Allied Med Sci and Clin Research 2015; 3(3): 293–97.

Gomez EC, Domingues ALC, de-Aguiar Júnior FCA,

dos Santos KRP, Rehn VNC, de Melo Lira MM and Barbosa CS. First record of prostatic schistosomiasis in Pernambuco, Brazil: signs of chronicity in an endemic disease. Rev Patol Trop 2016; 45: 132–8.

Yu Z, Wei C, Wang Y, Ye Z, Wang Z, Chen Z, Ni L,

Yang S, Gui Y, Guan Z, Cai Z and Lai Y. Prostatic Schistosoma japonicum with atypical immunophenotyping of individual glandular tubes: A case report and review of the literature. Southeast Asian J Trop Med Public Health 2013; 44(4): 568–73.

El-Bolkany MN, Mokhter NM, Ghonem MA and

Hussein MH. The impact of schistosomiasis on the pathology of bladder carcinoma. Cancer 1981; 48(12): 2643–8.

Tuffour I, Ayi I, Gwira TM, Dumashie E , Ashong Y and

Appiah-Opong R. Schistosoma egg antigen induces oncogenic alterations in human prostate cells. Analytical Cellular Pathology 2018:(1-2)–10.

Midzi N, Mduluza T, Mudenge B, Foldager L and

Leutscher PDC. Decrease in seminal HIV-1 RNA load after praziquantel treatment of urogenital schistosomiasis coinfection in HIV-positive men—an observational study. Open Forum Infect Dis 2017; 4(4): ofx199.

Leutscher PD, Host E and Reimert CM. Semen quality in

Schistosoma haematobium infected men in Madagascar. Acta Trop 2009; 109(1): 41–4.

Kjetland EF, Ndhlovu, PD, Gomo E, Mduluza T, Midzi

N, Gwanzura L, Mason PR, Sandvik L, Friis H and Gundersen SG. Association between genital schistosomiasis and HIV in rural Zimbabwean women. AIDS 2006; 20(4): 593–600.

Stecher CW, Kallestrup P, Kjetland EF, Vennervald B

and Petersen E. Considering treatment of male genital schistosomiasis as a tool for future HIV prevention: A systematic review. Int J Public Health 2015; 60(7): 839–48.

Kayuni S, Lampiao F, Makaula P, Juziwelo L, Lacourse

JE, Reinhard-Rupp J, Leutscher PDC and J. Stothard R. Systematic review with epidemiological update of male genital schistosomiasis (MGS): A call for integrated case management across the health system in sub-Saharan Africa. Parasite Epidemiol Control 2018:3:e00077.


  • There are currently no refbacks.