Clinical management outcomes and associated factors among prostate cancer patients receiving follow-up care at Kakamega county general teaching and referral hospital, Kenya

Abstract

At Kakamega County General Teaching and Referral Hospital, [KCGTRH] 245 of 375 prostate cancer patients— 65.3% — arrived with Stage IV metastatic disease. That single figure frames what this study documents: a cascade from late presentation through constrained treatment to outcomes bounded by palliation rather than cure. PSA screening uptake among eligible Kenyan men is estimated at under 5%, and most men in Western Kenya do not reach specialist care until symptoms have persisted for months. This study examined clinical management outcomes for prostate cancer patients attending follow-up care at KCGTRH between April 2024 and April 2025, drawing on 375 histologically confirmed records and key informant interviews with healthcare providers. Two frameworks guided the analysis: the Donabedian Structure–Process–Outcome (SPO) Model and the Chronic Care Model. Quantitative data were analyzed with SPSS; qualitative interviews were coded thematically through NVivo. Hormonal therapy was near-universal: 95.5% of patients received androgen deprivation therapy (ADT), and radical prostatectomy was entirely absent from the treatment record. Combination ADT plus docetaxel was used in 31.5% of patients. PSA declined in 54.1%; 76.5% achieved improved symptom control. Complete remission occurred in 2.4% of cases. Median event-free survival was 18.2 months (95% CI 15.6–20.8). Combination therapy and sustained ADT adherence independently predicted better outcomes. Bone pain, anaemia, and fatigue were the most common complications. Stage IV disease and metastatic spread were independently associated with shorter event-free survival. Age, rural residence, and educational attainment did not significantly alter outcomes — a finding that points to health-system barriers, not individual characteristics, as the dominant prognostic force. Most men at KCGTRH arrive too late for cure. The 2.4% complete remission rate and 18.2-month median event-free survival simultaneously mark an achievement and a gap. Community-based PSA screening, shorter referral pathways, expanded chemotherapy access, and radiotherapy installation at county level are the most direct responses. Within current infrastructure, the evidence supports prioritising combination ADT–docetaxel protocols and structured adherence support as the most attainable route to better outcomes for men already in the system.