Diagnostic and treatment factors associated with poor survival from prostate cancer are differentially distributed between regional and metropolitan Victoria, Australia

Abstract

Background: Men diagnosed with prostate cancer (PCA) in specific regional areas in Victoria, Australia have a poorer five-year survival rate compared to men living elsewhere in Victoria. This study aims to describe patterns-of- presentation and -care for men diagnosed with PCA in a specific regional Victorian area, and compare the outcomes with other Victorian regions. Methods: Information on consecutive men diagnosed between 2008 and 2013 was extracted from the Prostate Cancer Outcomes Registry-Victoria. Descriptive analyses summarized diagnostic and treatment patterns of the 7,204 men with PCA in the selected region (n = 373), metropolitan Melbourne (n = 2,565) and remaining areas of Victoria (n = 4,266) to compare risk factors, treatments and time-taken-to-treatment. Results: Men with PCA in the selected region were more likely to be diagnosed at older age (aged 68.6 vs 66 years in the rest of Victoria), and incidentally rather than through case-finding PSA blood tests. They were more likely to be presented with higher NCCN risk of the disease (High: 26 %, 24 % and 20.3 %; Very high/Metastasis: 11.8 %, 5.2 % and 5.7 % in the study region, metropolitan Melbourne and elsewhere in Victoria, respectively). Men in the selected region were also more likely to have a longer time from diagnosis to treatment (on average 15-30 days longer when compared to the rest of Victoria). Conclusions: Poorer outcomes of men with PCA in this specific region might be explained by multiple factors, including clinical-, patient-, and health-system-related. This range of explanatory factors, occurring at multiple points along the pathway of diagnosis and detection, suggests that interventions to improve outcomes for PCA in regional areas such as this need to be systematic. Interventions specifically addressing any one factor in isolation are unlikely to have much effect.