Factors Associated With Treatment Outcomes of Prostate Cancer Patients on Androgen Deprivation Therapy at Kenyatta National Hospital

Abstract

Background Androgen deprivation therapy is recommended in the management locally advanced and metastatic prostate cancer. The two available therapeutic options are orchiectomy and medical castration. The use of either orchiectomy or medical castration has proven to improve patient’s quality of life and overall survival of the patients. Hormonal deprivation therapy at Kenyatta National Hospital has been used to reduce testosterone levels in conjunction with other therapies. Treatment outcomes include castrate resistant prostate cancer, progression-free survival and overall survival of patients. Several factors e.g. Prostate specific antigen levels, type of androgen deprivation therapy and duration of treatment can influence outcomes. Objectives To determine the prevalence of androgen deprivation therapy use among prostate cancer patients, to characterize the clinical profiles of prostate cancer patients on androgen deprivation therapy and to determine the treatment outcomes and the factors associated with androgen deprivation therapy. Methodology This was a retrospective cross-sectional study. We sampled 90 prostate cancer patients who met the eligibility criteria. Simple random sampling method of medical records was used for adult patient ≥18 years seen at Kenyatta National Hospital, with prostate cancer between January 2016 and December 2019. A predesigned data collection form was used to abstract data from patient records. Descriptive and inferential data analysis was done in 90 patients. STATA software version 16 was used for analysis. Results Ninety patients were enrolled with a mean age of s 70 years (SD +8.3). All the ninety patients were on androgen deprivation therapy. Forty-four patients (48%) had T3b – T4 tumor staging while 34 (38%) had T3a tumor staging whereas 69 patients (76%) had G3-Gleason 7 -10. Fortyeight patients (53%) were treated with a combination of medical androgen deprivation therapy and radiotherapy. Of the 90 patients, 14 (16%) developed hormonal refractory prostate cancer while 76 (84%) were in progression free survival state with a mean survival of 30 months. Duration of treatment, hemoglobin level and post prostate specific antigen after therapy were

significantly associated with castrate resistant prostate cancer and progression free survival at multivariate analysis. Linear regression analysis results demonstrated an association between overall survival and duration of treatment. Conclusion All patients were started on androgen deprivation therapy. Fourteen patients developed castrate resistant prostate cancer while seventy-six were at progression free survival state. The factors that were significantly associated to androgen deprivation treatment outcomes were duration of treatment, hemoglobin level and post prostate specific antigen while duration of treatment was associated with overall survival of patients.