Social determinants of health associated with the clinicopathological presentation of patients with prostate cancer in Kenya
Charles Waihenya, S. M. Thumbi, Daniel Kinyuru Ojuka, Camille Ragin, Charnita Zeigler-Johnson
1 Introduction
Prostate cancer (PCa) is the second most frequently diagnosed cancer and the fifth leading cause of cancer-related deaths among men worldwide with an estimated 1.4 million new cases and 375,000 deaths in 2020. The burden of prostate cancer is projected to escalate, reaching nearly 2.3 million new cases and 740,000 deaths by 2040, primarily due to population growth and aging (1).
In the USA, a study on prostate cancer incidence by age and stage, found that 80% of the patients had localized disease (2). In Europe more than 80% of the disease is diagnosed at an early stage. In Sub Saharan Africa, middle East and Asia majority of patients present with advanced and metastatic disease with high mean PSA, and Gleason score >7 (3–9). PCa is the most common cancer in Kenya and the second leading cause of cancer mortality in males annually, with 3,582 new cases (21.9%) and 2,029 deaths (6.9%), respectively, in 2022 (10, 11). An estimated 88% of PCa patients in Kenya present with advanced disease, resulting in a high case-fatality rate. A local study reported that 87.5% of PCa patients presented with advanced disease in stage III/IV (12).
Histopathological staging is done with Gleason Score and is combined with clinical staging for prognosis and treatment.
PCa development and progression have multifactorial causes, including social determinants of health. The social determinants of health for PCa encompass various factors that influence an individual's risk, access to healthcare and overall wellbeing. These determinants can significantly impact the incidence, diagnosis and outcomes associated with PCa. These include socioeconomic factors such as education and income, neighborhood characteristics, social support, and the structure of social networks (13, 14). Socioeconomic status independently predicted the stage of prostate cancer at diagnosis. Cases from the highest socioeconomic status block group were more likely to present with localized disease compared to those from the lowest socioeconomic status group. Additionally, race also independently influenced the stage at which prostate cancer was diagnosed (15).
The absence of recent data on the stage at presentation, PSA, histology and their determinants among PCa patients in Kenya raises concerns about the status of the disease. Obtaining up-to-date information is crucial for informed decision-making in healthcare policy and practice. By determining the stages of PCa and clinicopathological factors and their social determinants, the study contributes to the clinical understanding of the disease. This can help health professionals with early diagnosis, effective treatment planning, and improve overall patient outcomes. It will also be leveraged in defining methods to improve social determinants of advanced PCa. The purpose of this study is to determine clinicopathological features, and social determinants associated with advanced disease in a Kenyan population.
