Clinical characteristics, survival rate and patients’ perceptions among patients diagnosed with prostate cancer receiving treatment at Ocean Road Cancer Institute in Dar Es Salaam, Tanzania: A mixed-method study

Background: In Tanzania, prostate cancer is the most commonly diagnosed cancer type and the leading cause of cancer-related death among men. Limited knowledge and stigma surrounding the disease can contribute to delayed diagnosis, hence, disease presentation at advanced stages. Clinical characteristics at diagnosis, survival rate and patients’ perceptions of the disease among prostate cancer patients have not been well studied in low resource countries. This information is critical in planning care, improving survival and downstaging prostate cancer in the region. Main Objectives: 1) To investigate the survival rate, and clinical characteristics at diagnosis and treatment modalities associated with survival among prostate cancer patients receiving care at ORCI. 2) To explore patients’ perceptions among prostate cancer patients receiving care at ORCI. Methods: This is a mixed-method study where both qualitative and quantitative research designs were employed. The quantitative design was a hospital-based retrospective cohort study involving prostate cancer patients who received services during the period 2018-2021. A medical record review was used to collect clinical, treatment and survival data from the study population. Descriptive, bivariate and logistic regression analyses were conducted for quantitative data. The qualitative design was semi-structured interviews with study participants at ORCI. Five participants were selected for semi-structured interviews, and a second interview was conducted with one participant. Thematic analysis was employed for qualitative analysis. Findings: A total of 160 participants with the mean age of 71.9 years were recruited in the quantitative study. The mean age at prostate cancer diagnosis was 68.7 years with two-thirds (68.2%) presenting with advanced disease (Tumor stage 3 and 4). Half of the patients presented with lower urinary tract symptoms (LUTS), bone pain (27.5%), and lower limb weakness (25.0%). Two-thirds (65.0%) presented with metastatic diseases and bone metastases were the most common metastatic site. 54% of the patients received palliative treatment, 92.5% received Androgen deprivation therapy (ADT), 48.8% chemoradiotherapy and 46.9% surgery with active surveillance. A three-year survival rate among the patients was estimated to be 75% and higher mortality were associated with advanced disease, as denoted by metastasis, particularly bone metastasis. The participants perceived the cause of prostate cancer being primarily old age and genetics. They shared the perception that early diagnosis and treatment could cure prostate cancer and they highlighted the need to educate community members to seek medical help and participate in prostate cancer screening. Barriers to seeking medical help were mainly financial challenges including high expenses for screening and treatment for prostate cancer. Conclusions and Recommendations: A substantial proportion of prostate cancer patients are diagnosed with advanced disease. The availability of various treatment modalities may explain better survival compared to other countries in the region. Despite existing barriers towards seeking medical help, the importance of early diagnosis and treatment is highlighted. Findings from this study underscore the need for continued health promotion to raise prostate cancer awareness among members of the community and the basis for such implementation of educational efforts needs to be established. Explorative research should be conducted to assess what are the best approaches to communicate to men and their communities about this sensitive topic. Continuing investment in prostate cancer care is of paramount importance to ensure affordable screening and treatment for all men in Tanzania