Background: Prostate cancer (PCa) is a significant and growing public health concern in Nigeria, representing the most common cancer among men. While global incidence rates are high, mortality is disproportionately higher in low-resource settings like Sub-Saharan Africa due to late presentation and diagnosis. Enugu State, a major demographic region in South-Eastern Nigeria, lacks comprehensive local data on the disease burden and its specific drivers, hindering effective public health intervention strategies.

Objective: This study aimed to determine the prevalence of prostate cancer and identify the associated risk factors among male patients presenting at major tertiary hospitals in Enugu State, Nigeria.

Methods A total of 1,250 consecutively recruited male patients aged 40 years and above, who presented with lower urinary tract symptoms or were due for routine screening, were included. Data were collected through structured questionnaires, clinical examinations, serum prostate-specific antigen (PSA) testing,

Main Findings: The prevalence of histologically confirmed prostate cancer among the study population was 18.4% (230/1250). The mean age at diagnosis was 68.7 ± 8.4 years. Multivariate analysis identified advanced age (≥65 years), a positive family history of prostate cancer in a first-degree relative, and obesity (BMI ≥30 kg/m²) as significant independent risk factors (p<0.05). Notably, over 75% of diagnosed cases presented with advanced disease (Gleason score ≥7 or clinical stage ≥III).