ABSTRACT

• Prostate cancer (PCa) is one of the most common cancers in men that usually
develops slowly. Since diagnostic methods improved in the last decade and are
highly precise, more cancers are diagnosed at an early stage. Active surveillance
or watchful waiting are appealing approaches for men diagnosed with low-risk
prostate cancer, and they are an antidote to the overtreatment problem and
unnecessary biopsies. However, treatment depends on individual circumstances
of a patient. Older hormonal therapies based on first generation antiandrogens
and steroids were widely used in metastatic castration-resistant prostate cancer
(mCRPC) patients prior to the implementation of docetaxel. Nowadays,
accordingly to randomized clinical trials, abiraterone, enzalutamide,
apalutamide. and docetaxel became first line agents administrated in the
treatment of mCRPC. Furthermore, radium-223 is an optional therapy for bone-
only metastasis patients. Sipuleucel-T demonstrated an overall survival benefit.
However, other novel immunotherapeutic showed limitations in monotherapy.
Possible combinations of new vaccines or immune checkpoint blockers with
enzalutamide
 Cont
• STATEMENT OF THE PROBLEM
PC affects most men above 50 years and this group is
known to be the at prime of their careers and
investments. Therefore, good review of best
treatment options available will help improve the
quality of life for this group. Additionally, there will
be positive effects to the economy of the country
because saving the lives and health of this group
means saving money and be channelled to other
sectors.
 CONT
• PURPOSE OF THE STUDY
This study identifies the evaluation of previous and current
pharmacotherapy of prostate cancer in men residing in
Makueni County that can be utilized in further studies and
the drafting of appropriate policies and designing of control
strategies on the disease appropriate for Kenya. The findings
of this study will contribute towards increased awareness and
knowledge of prostate cancer amongst the Makueni County
men, and lead to early detection, improved management of
the disease and reduced cost of patient care which should
enhance the quality of lives for prostate cancer patients.
 CONT
• Research design
• This was a cross-sectional descriptive study
among male respondents in Makueni County.
Quantitative approaches through structured
questionnaires was used to collect data on
demographic, socio-economic, awareness and
knowledge on prostate cancer, perception on
self-vulnerability to prostate cancer, and
uptake of prostate cancer screening.
 results
Table 4.1. Socio-demographic profiles of the study respondents

Variable No. %

Age (years)
Median (range) 38.0 (30.0-73.0)
30-39 353 60.7
40-49 156 26.9
≥50 72 12.4
Religious affiliation
Protestant 361 62.1
Catholic 198 34.1
Islam 12 2.1
Atheist 7 1.2
Traditionalists 3 0.5
Marital status
Married 475 81.8
Single 92 15.8
Separated 9 1.5
Widowed 5 0.9
Education level
University 86 14.8
Diploma 217 37.3
Secondary 235 40.5
Primary 42 7.2
No education 1 0.2
Occupation
Formal employment 351 60.4
Business 194 33.4
Unemployed 36 6.2
cont
cont
cont
 cont
Knowledge levels on prostate cancer
Variable (Total N = 581) No. %

Knows the age at-risk of prostate cancer in men

<40 years 47 8.1
40 years 372 64.0
Don't know 162 27.9
Knows the signs and symptoms of prostate cancer
Yes 158 27.2
No 423 72.8
Knows that prostate cancer is treatable
Yes 333 57.3
No 248 42.7
Knows of a mode(s) of prostate cancer treatment
Yes 168 50.5
No 165 49.5
Knows that prostate cancer is preventable
Yes 279 48.0
No 302 52.0
Knows of a mode(s) of prostate cancer prevention
Yes 272 97.5
No 7 2.5
Knows of a person suffering from prostate cancer
Yes 267 46.0
No 314 54.0
Knows of a person who has died from prostate
cancer
Yes 165 28.4
No 416 71.6
cont
 conclusions
• Conclusions
• levels of prostate cancer are high among men in Makueni County. Overall, only
about a half of the respondents had good knowledge levels on prostate cancer
with less than a half of them knowing the signs and symptoms, treatment and
preventive measures for prostate cancer.
• Knowledge levels on prostate cancer are influenced by educational levels
among men in Makueni County.
• Perception levels on self-vulnerability to prostate cancer are low among men in
Makueni County and are influenced by religious affiliation, knowledge and
educational levels.
• The uptake of prostate cancer screening is very low among men in Makueni
County; however most of the men are willing to undertake prostate cancer
screening and know more about the disease.
• There is a close association between education levels, good knowledge on
• PC, and good perception on self-vulnerability to PC.
 recommedation
• Recommendations
• The Ministry of Health at national and county levels, and cancer
stakeholders to promote information on the signs and symptoms,
treatment and preventive measures of prostate cancer that will enhance
further awareness and knowledge of the disease.
• The Ministry of Health at national and county levels, and cancer
stakeholders to promote good knowledge on prostate cancer to increase
men’s perception of self-vulnerability towards the disease and hence
increase PC screening uptake amongst men at risk in the Nairobi County.

• The Ministry of Health at national and county levels should expand

screening services at health facilities and public health promotion will
enhance uptake of prostate cancer screening leading to ameliorating the
burden of the disease in Kenya.
 objective
• General objective
• To determine the evaluation of previous and current
pharmacotherapy of prostate cancer among men in Makueni
County hospital, Kenya

• Specific objectives
• To determine the previous pharmacotherapy of PC Makueni
County hospital
• To evaluate the current pharmacotherapy of PC Makueni County
hospital
 Methods of data collection
• Data collection techniques
• The data was collected through questionnaires with
structured questions administered to the adult males 30
years and above within each household. The structured
questions provided data that was objective and reliable
for hypothesis testing. The principle researcher
coordinated and ensured that the data collection process
was properly administered. Research assistants were
carefully be selected and trained on how to administer
the questionnaires. The data collection instrument was
done though English language.
 cont
• Sample size determination
• The sample size was determined based on the formula of (Rosner, 2011) for binomial
probability exact methods for one sample tests as follows:

• Where: p0 = awareness levelsin makueni men ≥50 years was 80% (Oladimeji et al.,
• 2010)
• p1 = Since awareness levels on prostate cancer have previously not been determined for
men in Kenya, it was assumed based on 80% awareness levels in kenya men (Oladimeji et
al., 2010) that awareness levels among Kenyan men is at least 75%.
•  = probability of type I error and z = 1.96 (at  = 5% 2-tailed)
•  = probability of type II error and z1- = -0.157 (at 83% power 2-tailed)  = 0.03 (sum of
binomial probabilities for exact methods for one sample tests) n = 0.517/0.0009 n = 574
• 1% (n=6) of the sample was added to cater for incomplete responses. This figure was
chosen because 100% response was obtained during the pilot study and it was anticipated
that similar response would be achieved during the study. Therefore, 581 respondents
were enrolled into this study.
 reference
• Morgentaler, A., Rhoden, E. L., Guay, A., & Traish, A. (2010). Serum testosterone is associated with aggressive prostate cancer
in older men: results from the Baltimore Longitudinal Study of Aging. BJU Int, 105(6), 884-885; author reply 885-886.
• MPHS, & MMS. (2011). National Cancer Control Strategy 2011-2016.
• Retrieved 7th June, 2013, from http://www.ipcrc.net/pdfs/KenyaNational-Cancer-Control-strategy.pdf
• Nanton, V., & Dale, J. (2011). It don't make sense to worry too much: the experience of prostate cancer in African-Caribbean
men in the UK. Eur J Cancer Care (Engl), 20(1), 62-71.
• Ngugi, P. M., & Byakika, B. (2007). Histology of specimens taken by prostatectomy and needle biopsy. East Afr Med J, 84(8),
363-366.
• Ngugi, P. M., & Magoha, G. A. (2007). The management of early prostate cancer: a review. East Afr Med J, 84(9 Suppl), S24-30.
• Nivens, A. S., Herman, J., Pweinrich, S., & Weinrich, M. C. (2001). Cues to participation in prostate cancer screening: a theory
for practice. Oncol Nurs Forum, 28(9), 1449-1456.
• Oghenetejiri, U. E. (2009). Factors influencing Men’s decision to undergo prostate specific antigen testing at the University of
Benin Teaching Hospital, Nigeria: Qualitative study. Arch Ibadan Med, 1(12), 3-5.
• Okobia, M. N. (2003). Cancer Care in sub-Saharan Africa – Urgent Need for Population–based Cancer Registries. Ethiop J Health
Dev, 17(2), 89-98.
• Oladimeji, O., Bidemi, Y. O., Olufisayo, J. A., & Sola, A. O. (2010). Prostate cancer awareness, knowledge, and screening
practices among older men in Oyo State, Nigeria. Int Q Community Health Educ, 30(3), 271286.
• Olusoga, O. D., Adedapo, K. S., Okafor, P. N., & Daini, O. A. (2007). Incidence of syphilis in prostate specific antigen samples of
patients attending cancer screening unit in Nigeria. Afr J Biomed Res, 10(2007), 25-31.
• Parchment, Y. D. (2004). Prostate cancer screening in African American and Caribbean males: detriment in delay. ABNF J, 15(6),
116-120.
• Punga-Maole, A. M., Moningo, D. M., Kayembe, P. K., Tshikuela, M. L., & Kabongo, J. M. (2008). Study of prostate cancer
screening in a population of employees of a Kinshasa company in the Democratic Republic of Congo. Detection rate and
nutritional and geographical risk factors. Prog Urol, 18(8), 512-518.
• Rebbeck, T. R., Devesa, S. S., Chang, B. L., Bunker, C. H., Cheng, I., Cooney, K., et al. (2013). Global patterns of prostate cancer
incidence, aggressiveness, and mortality in men of african descent. Prostate Cancer, 2013, 560857.
• Roobol, M. J., Kerkhof, M., Schroder, F. H., Cuzick, J., Sasieni, P., Hakama, M., et al. (2009). Prostate cancer mortality reduction
by prostatespecific
 cont
• mortality: Physicians' Health Study. J Natl Cancer Inst, 101(20), 1406-1411.
• Steele, C. B., Miller, D. S., Maylahn, C., Uhler, R. J., & Baker, C. T. (2000). Knowledge, attitudes, and
screening practices among older men regarding prostate cancer. Am J Public Health, 90(10), 1595-
1600.
• UN (2011). Men in families and family policy in a changing world (No. ST/ESA/322). New York. (U.
Nations o. Document Number)
• Wasike, R. W., & Magoha, G. A. (2007). Descriptive case series of patients presenting with cancer of
the prostate and their management at Kenyatta National Hospital, Nairobi. East Afr Med J, 84(9
Suppl), S3135.
• Wu, C. C., Pu, Y. S., Wu, H. C., Yang, C. Y., & Chen, Y. C. (2011). Reversed association between levels of
prostate specific antigen and levels of blood cadmium and urinary cadmium. Chemosphere, 83(8),
1188-1191.
• Xu, J., Neale, A. V., Dailey, R. K., Eggly, S., & Schwartz, K. L. (2012). Patient perspective on watchful
waiting/active surveillance for localized prostate cancer. J Am Board Fam Med, 25(6), 763-770.
• Yamoah, K., Beecham, K., Hegarty, S. E., Hyslop, T., Showalter, T., & Yarney, J. (2013). Early results of
prostate cancer radiation therapy: an analysis with emphasis on research strategies to improve
treatment delivery and outcomes. BMC Cancer, 13, 23.
• Zeegers, M. P., Jellema, A., & Ostrer, H. (2003). Empiric risk of prostate carcinoma for relatives of
patients with prostate carcinoma: a metaanalysis. Cancer, 97(8), 1894-1903.