Patterns of care for men with prostate cancer: the 45 and Up Study

Abstract

rostate cancer is the most frequently diagnosed cancer in Australian men; about 19 508 cases were diagnosed in 2019. 1 Treatment options include surgery, radiotherapy, and active surveillance. Survival rates for men with localised prostate cancer are similar with all options, but the side effects profiles differ markedly, including higher rates of urinary incontinence and sexual dysfunction after surgery and of rectal bleeding after radiotherapy. 2,3 Population-based studies of patterns of care in Victoria and South Australia (2016) 4 and Victoria alone (2020) 5 have been published, but the only recent population-based study of factors associated with prostate cancer treatment types in New South Wales investigated the treatment of Aboriginal men. 6 Further, the factors that determine the type of treatment received by men with prostate cancer, and the consequent costs, have been subjects of controversy. 7,8 The aims of our study were therefore to describe the patterns of care for men in the NSW 45 and Up Study with prostate cancer, and to ascertain the factors associated with receiving different types of treatment. MethodsA total of 267 153 NSW men and women aged 45 years or more were enrolled in the 45 and Up Study of the Sax Institute, Sydney, during January 2006 -December 2009. 9 The 45 and Up Study is a large cohort study of people aged 45 or more investigating exposures and outcomes of public health importance for older people. Prospective participants were randomly selected from the Services Australia (formerly the Australian Department of Human Services) enrolment database. Enrolled participants completed a postal baseline questionnaire comprising 58 questions about health, lifestyle, and socio-demographic characteristics and consented to linkage of their data with administrative health datasets. Data collection and linkageThe record linkage undertaken has been described previously. 10 The datasets linked to the 45 and Up Study baseline questionnaire data were:• Medicare Benefits Schedule (MBS) claims, to June 2016; • Pharmaceutical Benefits Scheme (PBS) claims, to June 2016; • the NSW Cancer Registry, to December 2013; • the NSW Admitted Patient Data Collection (APDC; public and private hospital inpatient services), to June 2016; and• the NSW Register of Births, Deaths and Marriages, for deaths to June 2016.

Referral to radiation oncology prior to prostatectomy: Referral rates in a New Zealand tertiary Centre

“…Men with private insurance were also included in the Australian study and holding private insurance is associated with higher rates of prostatectomy and lower radiotherapy rates. 8,9 We found several factors associated with the likelihood of radiation oncology referral. Referral rates were unsurprisingly lower with younger age and was consistent with our finding that young age was the most common reason for urologists to recommend surgery over radiotherapy.…”

“…These referral rates are higher than the findings of a New South Wales, Australia study where only 12% of men who underwent prostatectomy for localised prostate cancer between 2006 and 2013 were referred to radiation oncology before surgery. 8 The higher rate of referral may be related to differences in regional practices, GP and urologist education, and/or patient awareness between the two time periods. Men with private insurance were also included in the Australian study and holding private insurance is associated with higher rates of prostatectomy and lower radiotherapy rates.…”

Welcome to 2022: the Year of the Tiger!

“…For men with localised prostate cancer, in particular, the evidence with respect to clinical outcomes and survival favours neither surgery or radiotherapy over the alternative, and financial considerations and access to treatment probably influence choice of therapy. 13 In an accompanying editorial, Henry Woo (Sydney Adventist Hospital Clinical School, University of Sydney; Chris O'Brien Lifehouse, Sydney) and Amy Teh (Icon Cancer Centre, Sydney) argued that men with prostate cancer should be comprehensively informed about all treatment options, to facilitate an informed personal decision and to avert later decision regret, and that the treatment model most likely to achieve best outcomes is multidisciplinary in nature. 14 Until 2019, a finding at colonoscopy of non-advanced adenoma (one or two small lesions with low grade dysplasia) was typically followed in Australia by a follow-up colonoscopy five years later, but the recommended surveillance interval is now ten years.…”

Robotic Salvage Seminal Vesiculectomy for radio-recurrent prostate cancer post LDR brachytherapy following multiple negative trans-perineal biopsies

“…Prostate cancer (PCa) is the second most diagnosed cancer in men with approximately 1.3 million cases diagnosed globally per annum. 1 In Australia, 27% of men who undergo active treatment receive a form of radiotherapy. 1 The application of multi-parametric Magnetic Resonance Imaging (mp-MRI) and prostate membrane specific antigen positron emission tomography (PSMA-PET) CT scan has led to enhanced detection of local and metastatic recurrence post-radiotherapy.…”

“… 1 In Australia, 27% of men who undergo active treatment receive a form of radiotherapy. 1 The application of multi-parametric Magnetic Resonance Imaging (mp-MRI) and prostate membrane specific antigen positron emission tomography (PSMA-PET) CT scan has led to enhanced detection of local and metastatic recurrence post-radiotherapy. This may lead to increased recognition of unusual patterns of disease recurrence for which there is little data to guide management.…”