Abstract
BackgroundLittle is known about the healthcare process for patients with prostate cancer, mainly because hospital-based data are not routinely published. The main objective of this study was to determine the clinical characteristics of prostate cancer patients, the, diagnostic process and the factors that might influence intervals from consultation to diagnosis and from diagnosis to treatment.MethodsWe conducted a multicentre, cohort study in seven hospitals in Spain. Patients’ characteristics and diagnostic and therapeutic variables were obtained from hospital records and patients’ structured interviews from October 2010 to September 2011. We used a multilevel logistic regression model to examine the association between patient care intervals and various variables influencing these intervals (age, BMI, educational level, ECOG, first specialist consultation, tumour stage, PSA, Gleason score, and presence of symptoms) and calculated the odds ratio (OR) and the interquartile range (IQR). To estimate the random inter-hospital variability, we used the median odds ratio (MOR).Results470 patients with prostate cancer were included. Mean age was 67.8 (SD: 7.6) years and 75.4 % were physically active. Tumour size was classified as T1 in 41.0 % and as T2 in 40 % of patients, their median Gleason score was 6.0 (IQR:1.0), and 36.1 % had low risk cancer according to the D’Amico classification. The median interval between first consultation and diagnosis was 89 days (IQR:123.5) with no statistically significant variability between centres. Presence of symptoms was associated with a significantly longer interval between first consultation and diagnosis than no symptoms (OR:1.93, 95%CI 1.29–2.89). The median time between diagnosis and first treatment (therapeutic interval) was 75.0 days (IQR:78.0) and significant variability between centres was found (MOR:2.16, 95%CI 1.45–4.87). This interval was shorter in patients with a high PSA value (p = 0.012) and a high Gleason score (p = 0.026).ConclusionsMost incident prostate cancer patients in Spain are diagnosed at an early stage of an adenocarcinoma. The period to complete the diagnostic process is approximately three months whereas the therapeutic intervals vary among centres and are shorter for patients with a worse prognosis. The presence of prostatic symptoms, PSA level, and Gleason score influence all the clinical intervals differently.
Highlights
Little is known about the healthcare process for patients with prostate cancer, mainly because hospital-based data are not routinely published
The study group was composed of 470 patients
The mean body mass index (BMI) was 28.1 (SD:4.5) and 354 (75.4 %) had no physical limitations according to the ECOG WHO performance status
Summary
Little is known about the healthcare process for patients with prostate cancer, mainly because hospital-based data are not routinely published. With an incidence of 65.2 per 100 000 persons per year (27 853 new cases yearly 21.7 % of the total cancer in men), it is overall the second most frequent cancer in Spain [1]. Worldwide, it is the second most frequently diagnosed cancer among men (1 111 689 new cases, 15.0 % of all cancers in men) and overall the fourth most common cancer [1]. The incidence of prostate cancer has increased over the last decades, partly due to the more frequent use of diagnostic tools such as prostate-specific antigen (PSA) testing and needle biopsies in asymptomatic men [2,3,4]. Prostate cancer reduces the quality of life of patients [7, 8]
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