Clinical and socio‐demographic profile of an Australian multi‐institutional prostate cancer cohort

Abstract

Aims:To describe the clinical and socio-demographic data from a South Australian prostate cancer cohort (PCCOD). Methods: Clinical data for 2329 prostate cancer patients treated at three South Australian teaching hospitals between 1998 and 2007 were analyzed by place of residence, time of diagnosis and socioeconomic status (SES). c 2 tests were used to investigate differences in stage, grade and prostate-specific antigen (PSA) at diagnosis, among subgroups and over time. Logistic regression was used to examine predictors of treatment modalities. Five-year survival was assessed using Kaplan-Meier methods. Results: The distributions of age, SES and place of residence of PCCOD patients closely reflected those of the state-based prostate cancer population, with rural patients slightly underrepresented. Lower SES or rural residence was not associated with higher stage, grade, PSA level or disease-specific survival. Treatment modalities varied with SES (for radical prostatectomy), rural residence (radical prostatectomy, radiotherapy and androgen ablation), age and clinical characteristics. There was a trend over time towards a younger age at diagnosis and more favorable clinical profiles, consistent with earlier diagnosis. However, the current risk profile for this cohort is similar to that reported approximately a decade earlier in a US series. Conclusion: PCCOD patients have a broadly similar socio-demographic profile to prostate cancer patients statewide. Socioeconomic status is not associated with clinical characteristics at diagnosis, but does predict treatment type. The clinical characteristics of the cohort are consistent with a much later stage presentation than reported in current US case series.

Patterns of care for men diagnosed with prostate cancer in Victoria from 2008 to 2011

“…However, this comparison is based on different methods of data collection — treatment for men in the 1993 study was determined by surveying the treating clinicians 3 years after diagnosis, whereas our 2008–2011 treatment data were collected 12 months after diagnosis. The proportion of men who had no active treatment in our study (22.7%) is similar to that in a US Medicare‐linked study (about 23% for men diagnosed in 2007) 10 and a South Australian study monitoring men treated in the public health system (about 20% of men diagnosed from 1998 to 2007) 11 . Men with low‐risk disease in our study were four times more likely to receive no treatment compared with men with low‐risk disease in 40 urology practices in the United States and recruited to the Cancer of the Prostate Strategic Urologic Research Endeavor (CAPSURE) registry (40.6% v 9%) 12 .…”

“…The apparent change in patterns of prostate cancer management in Victoria is consistent with results of studies undertaken in Queensland 16 and New South Wales 17 . In contrast, the institutionally based South Australian registry shows a consistent proportion of men treated with RP (23% over the 1998–2007 study period), or possibly a slight decline 11 …”

“…We identified a sixfold decline in hormonal therapy as front‐line treatment for prostate cancer compared with the 1993 Victorian study (38.8% to 6.0%) 7 . This downward trend was also reported in the South Australian study, although it was less pronounced (OR, 0.58 [95% CI, 0.40–0.82] for men diagnosed between 2004 and 2006 compared with those diagnosed between 1998 and 2000) 11 …”

“…Our finding that almost half of men with clinically localised disease had RP is similar to the 50% rate of RP described for men recruited to the CAPSURE registry 12 . In contrast, much lower rates have been reported elsewhere: 12%–16% in US Medicare‐linked reviews (which captured only men older than 64 years and those with a disability or end‐stage renal disease), 10 , 13 11% in a population‐based dataset from Northern England, 14 23% in the study of men in South Australia who were treated in the public health system, 11 and 13% in the previous study of men in Victoria 7 …”

Australian validation of the Cancer of the Prostate Risk Assessment Post‐Surgical score to predict biochemical recurrence after radical prostatectomy

“…This study used data from the South Australian Prostate Cancer Clinical Outcome Collaborative (SA‐PCCOC) database. This is a state‐wide multi‐institutional clinical which prospectively collects clinical, treatment and outcome data for men with PCa, independently of the treating physician, from both the public and private sectors . The study population consisted of registry participants who were residing in South Australia and underwent RP as primary treatment for localized PCa diagnosed 1998–2013.…”