Abstract
Men living in regional and remote areas experience disparities in prostate cancer (PrCa) diagnosis, clinical characteristics and treatment modalities. We sought to determine whether such disparities exist in PrCa patients from Tasmania; a regional state of Australia with the second-highest rate of diagnosis and where over a third of residents live in outer regional and remote areas. Our study included clinicopathological data from 1526 patients enrolled in the Prostate Cancer Outcomes Registry-Tasmania. Regression analyses were undertaken to determine whether demographic, clinical and treatment variables differed between inner regional and outer regional/remote patients. Men from outer regional/remote areas were significantly more likely to reside in lower socio-economic areas, be diagnosed at a later age and with more clinically aggressive features. However, in contrast to previous studies, there were no overall differences in diagnostic or treatment method, although men from outer regional/remote areas took longer to commence active treatment and travelled further to do so. This study is the first to investigate PrCa disparities in a wholly regional Australian state and highlights the need to develop systematic interventions at the patient and healthcare level to improve outcomes in outer regional and remote populations in Australia and across the globe.
Highlights
Men living in regional and remote areas experience disparities in prostate cancer (PrCa) diagnosis, clinical characteristics and treatment modalities
The inner regional and outer regional/remote groups differed in the distribution of age and Australian Bureau of Statistics (ABS)-developed Socio-Economic Indexes for Areas (SEIFA) index, and in terms of clinical characteristics other than method of diagnosis
The prevalence of men living in outer regional/remote areas was elevated among older persons, those from the middle to lower end of the SEIFA distribution, those with moderate to high prostate-specific antigen (PSA) levels (10.01–20 ng/ mL) at diagnosis, those with high-risk disease, those diagnosed in public facilities, and those treated in public facilities
Summary
Men living in regional and remote areas experience disparities in prostate cancer (PrCa) diagnosis, clinical characteristics and treatment modalities. A study utilising data from the Movember-funded Prostate Cancer Outcomes Registry-Victoria (PCOR-VIC) observed that males residing in a particular rural region of the state were older at diagnosis and more likely to have disease detected during other health procedures, rather than through preventative testing or m onitoring[4]. These individuals presented with significantly higher prostate-specific antigen (PSA) levels and Gleason scores at diagnosis and experienced a prominent delay between diagnosis and the commencement of treatment[5], a factor that could adversely affect outcomes[6]. Through analysis of these data, we aimed to provide insight into where and why these disparities occur to inform and target interventions where they are most needed, potentially leading to better outcomes in regional populations
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