Objective: To describe patterns of care for men diagnosed with prostate cancer
in Victoria, Australia, between 2008 and 2011.
Design, setting and patients: Men who were diagnosed with prostate cancer at
11 public and six private hospitals in Victoria from August 2008 to February 2011,
and for whom prostate cancer notifications were received by the Prostate
Main outcome measures: Characteristics of men diagnosed with prostate
cancer; details of treatment provided within 12 months of diagnosis, according
to National Comprehensive Cancer Network risk categories; and characteristics
of men who did not receive active treatment within 12 months of diagnosis.
Results: Treatment details were collected for 98.1 of men who were assessed
as eligible to participate in the study (2724/2776) and were confirmed by
telephone 12 months after diagnosis for 74.4 of them (2027/2724). Most
patients (2531/2724 [92.9 ) were diagnosed with clinically localised disease, of
whom 1201 (47.5 ) were at intermediate risk of disease progression. Within 12
months of diagnosis, 299 of the 736 patients (40.6 ) who had been diagnosed
as having disease that was at low risk of progression had received no active
treatment, and 72 of 594 patients (12.1 ) who had been diagnosed as having
disease that was at high risk of progression had received no active treatment.
Of those diagnosed as having intermediate risk of disease progression, 54.5
(655/1201) had undergone radical prostatectomy. Those who received no active
treatment were more likely than those who received active treatment to be
older (odds ratio [95 CI], 2.96 [2.01?4.38], 10.94 [6.96?17.21] and 32.76 [15.84?
67.89], respectively, for age 65?74 years, 75?84 years and 85 years, compared
with <55 years), to have less advanced disease (odds ratio [95 CI], 0.20 [0.16?
0.26], 0.09 [0.06?0.12] and 0.05 [0.02?0.90], respectively, for intermediate, high
and very high-risk [locally advanced] or metastatic disease, compared with lowrisk
disease) and to have had their prostate cancer notified by a private hospital
(odds ratio [95 CI], 1.35 [1.10?1.66], compared with public hospital).
Conclusion: Our data reveal a considerable ?stage migration? towards earlier
diagnosis of prostate cancer in Victoria and a large increase in the use of radical
prostatectomy among men with clinically localised disease.