Social determinants of health associated with the clinicopathological presentation of patients with prostate cancer in Kenya

Introduction: In Kenya prostate cancer (Ca) is the leading cause of cancer related mortality among men. There is lack of data on the social determinants of health and their impact on the stage at diagnosis. Purpose: The purpose of this study was to determine prostate cancer stage at diagnosis, and social determinants associated with advanced disease in a Kenyan population. Methods: We analyzed data from 170 prostate cancer patients recruited from Kenyatta National Hospital (KNH) and MP Shah Hospital, Nairobi (2022–2024) on patients prospectively recruited in the International Registry for Men with Advanced Prostate Cancer (IRONMAN) and African Cancer Genome Registry (ACGR) registries. Patients included in the study had a histological diagnosis of prostate cancer. All participants completed standardized questionnaires assessing sociodemographic factors, health knowledge, and healthcare access. Clinical and pathological staging data was also collected and multivariable logistic regression used to determine factors associated with metastatic disease at diagnosis. Results: The mean age for the participants was 70 years. Most of the participants presented with advanced disease 84.7% (n = 144). Half of the participants (50%, n = 84) had a Gleason score of 9 and 10 or an ISUP (International Society of Urological Pathology) Grade 5, 36% (n = 60) had grades 3 and 4 the remaining 14% (n = 24) had grade 1 and 2. The median PSA was 81 ng/ml (IQR: 26.5–262) and the mean was 402.22 ng/ml (SD:1128.17) with most of the patients 60.5% (n = 92) having a PSA over 50 ng/ml. The odds of advanced disease were significantly lower among patients with tertiary education compared to primary or no formal education (OR = 0.0.13 95% CI: 0.03–0.56). Patients who were very spiritual had higher odds of advanced disease (OR = 4.51 95% CI: 1.33–15.22). Conclusion: Kenyan men in this cohort present predominantly with advanced prostate cancer, influenced by educational status, spirituality and region of residence. There is need for community-based awareness and screening programs for men with low education.