Oral Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

Rural variations in primary care prostate cancer diagnosis and survival: A cohort study using linked Australian Primary Care Electronic Medical Record data (125871)

Meena Rafiq 1 , Olivia Wawryk 1 , Ian M Collins 2 , Alex Lee 1 , Mark Buzza 2 , Simonne Neil 2 , Jessica Freeman 2 , Jon Emery 1
  1. University of Melbourne / Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
  2. Victorian Comprehensive Cancer Centre, VCCC, Melbourne, VIC, Australia

Objectives/purpose

Prostate cancer outcomes are poorer in rural areas compared with metropolitan. Prostate Specific Antigen (PSA) blood tests are commonly used in primary care to investigate suspected prostate cancer. Understanding variations in PSA test use and follow-up of abnormal results between rural and metropolitan areas could identify causes of disparities in prostate cancer outcomes.

Sample and setting

A longitudinal cohort study using linked Victorian primary care and cancer registry data. Males aged ≥18 years, diagnosed with prostate cancer between 30/6/2010 to 31/7/2022 who visited a primary care practice in the year pre-diagnosis and had a PSA test were included.

Procedures

Logistic regression compared demographic and tumour characteristics between rural and metropolitan patients and the occurrence and timing of abnormal PSA results pre-diagnosis. Poisson regression estimated trends in PSA test use pre-diagnosis. Kaplan-Meier curves quantified overall and cancer-specific survival rates.

Results

2,470 prostate cancer patients were included (52% rural, 48% metropolitan). Rural patients had higher Gleason scores and were twice as likely to have significantly elevated (>20ng/mL) PSA levels at diagnosis. There were prolonged diagnostic intervals (from first abnormal PSA test to cancer diagnosis) of 7 months in metropolitan patients and 8 months in rural patients. In both rural and metropolitan areas, two-thirds of patients with a PSA >3ng/ml did not have guideline concordant care (a repeat PSA test within 3 months).

Conclusion and clinical implications

Victorians in rural areas with prostate cancer have higher PSA levels and Gleason scores at diagnosis and experience longer diagnostic intervals compared to metropolitan patients. Across Victoria, abnormal PSA tests are frequently detected several months before prostate cancer diagnosis and there is low guideline concordance regarding repeat tests. Targeted interventions to identify and follow up abnormal PSA blood tests results in primary care could expedite diagnosis and reduce rural-metropolitan disparities in prostate cancer outcomes.