Demographic Factors and Clinical Determinants of Stage of Presentation of Prostate Cancer in Patients Seen at the Kenyatta National Hospital

Abstract

Study background: Low-and-middle income countries with poor socioeconomic factors and poor healthcare structures, report lower incidence rates of prostate cancer but high morbidity at late diagnostic stage than when compared to high income countries with better socioeconomic and healthcare systems. This disparity in incidence rate and stage of diagnosis may be explained by demographic factors of health encompassing health seeking behavior that influences screening patterns and the stage of diagnosis of prostate cancer. It remains unknown the stages in which patients in Kenya present with prostate cancer and the role of screening programs in reducing morbidity and mortality from prostate cancer. Broad objective: The aim is to explore the demographic characteristics and clinical factors influencing the stage at which prostate cancer is diagnosed in patients at Kenyatta National Hospital (KNH). Study design: Retrospective study Study site: Kenyatta National Hospital Participants and methods: Seventy-Eight patients seen with prostate cancer from January 2018 – December 2022 were recruited and their file records interrogated for the relevant data. Outcome variable was stage of presentation with exposure variables being clinical and demographic factors. Results: The average age of the patients was 69.3 years, with 84% employed in the informal sector. Kikuyu ethnicity was the most represented at 38%, followed by Kamba at 15.4%. Lower urinary tract symptoms (LUTS) and back pain were the most frequently reported symptoms, occurring in 67.5% and 65% of cases, respectively. A family history of prostate cancer was noted in only 17% of the patients. The average Prostate Specific Antigen (PSA) level at the time of diagnosis was 406.6 ng/ml. Histopathological analysis showed that 41.1% of the cases were classified as International Society of Urologic Pathologists (ISUP) grade group 5, with 28% falling into ISUP grade 4. In terms of disease stage, 61.8% of patients were diagnosed with metastatic disease. Conclusion: Prostate cancer is a disease of older men with a mean age of presentation of 69 years. Demographic patterns indicate that ethnicity and occupation could influence the patterns of presentation. Most patients continue to present with advanced disease. Screening and early diagnosis are recommended to promote detection of early disease.