Why are mortality rates for men with prostate cancer higher in one region of Victoria than in most Victorian Integrated Cancer Services?

Research output: Contribution to conferenceAbstract


Objective: The aim of this research was to evaluate factors associated with poorer survival outcomes of men with prostate cancer (PC) in one regional area and compare the outcomes with the rest of Victoria. We also sought to explore the perceptions and experiences of PC diagnosis, treatment, and care among men with and without a diagnosis of PC and to ascertain the perceptions of General Practitioners (GPs) on these matters.

Methods: Information on consecutive men diagnosed 2008–2013 was extracted from the Prostate Cancer Outcomes Registry-Victoria. Descriptive analyses summarized diagnostic and treatment patterns of 7,204 men with PC in the selected area (n = 373), metropolitan Melbourne (n = 2,565) and remaining areas of Victoria (n = 4,266). In-depth interviews were conducted with 10 men with PC and 10 men without PC; structured interviews were conducted with 10 GPs. About half of the participants were from the regional area and the remainder from metropolitan Melbourne.

Results: Men in the selected area were more likely to be diagnosed at an older age (68.6 years) than men in the rest of Victoria (66 years) with more advanced disease, and incidentally rather than through case-finding PSA blood tests. In risk groups where immediate treatment is often indicated, they were less likely to have immediate treatment and had a longer time (by ~30 days) from diagnosis to treatment than men in the rest of Victoria. Men in this area seemed more likely to accept medical advice than men in metropolitan areas, who described a more consultative process. Relationships with GPs, expectations, and attitudes to healthcare varied with the individual rather than the area of residence. GPs thought that most men wanted PSA testing and were willing to undergo rectal examination. Some GPs found it confusing to confront inconsistent case-finding guidelines from different professional bodies. They would welcome resources to support them in educating patients about PC. Apart from referral patterns and infrequent GP visits, GPs found it hard to explain differences in outcomes between men with PC in regional and metropolitan areas.

Conclusions: Poorer outcomes of men with PC in this area might have multiple explanations, including clinical, patient, and health-system factors. These explanatory factors, occurring at multiple points along the pathway of diagnosis and detection, suggest that interventions to improve outcomes for PC in regional areas need to be systemic. Interventions at any one link in the start-to-end chain of managing PC in men from this region are likely to be ineffectual, and—to the extent it distracts from the whole and focuses resource allocation on one link—counterproductive.
Original languageEnglish
Number of pages1
Publication statusPublished - 2016
Event17th Asia-Pacific Prostate Cancer Conference 2016 - Melbourne Convention and Exhibition Centre , Melbourne, Australia
Duration: 31 Aug 20163 Sep 2016


Conference17th Asia-Pacific Prostate Cancer Conference 2016

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