Prostate cancer outcome disparity in South West Victoria

Abstract

Aims: The Australian Cancer Atlas reported incidence and mortality of prostate cancer across four distinct regions of SouthWestVictoria.We analysed these outcomes in detail. Method(s):We described incidence and outcomes for these regions and explore variations using the Evaluation of Cancer Outcomes Database that includes all newly diagnosed cancer patients from 2009 to 2015, an initiative of the Barwon South Western Region Integrated Cancer Services. Regions and their male population includes (a) Bellarine Peninsula (28 545), (b) Greater Geelong, Surf Coast, Colac Otway Shire, Corangamite (117 809), (c) Moyne, Warrnambool and Southern Grampians (28 284), (d)Glenelg (9739). Region 2with the largest population is a metropolitan area,while regions 1, 3 and 4 are regional/rural. Result(s): Patients diagnosed (2009 to 2015) per region were 298 (1.04%): 1085 (0.92%): 273 (0.97%): 120 (1.2%), respectively. There was no significant difference across the regions in variables including; marital status, smoking history, Gleason score and treatment. There was a trend towards older age in region 3 (median age 68.8 years). The 5-year survival rate was 85%, 76%, 71% and 80% in each region, respectively. This compares to the national average of 95%. PSA scores >20 ng/mL at diagnosis, as a surrogate for high-risk disease occurred in 23%, 29%, 22% and 21%, respectively (P < .01). The proportions presenting with stage IV disease were 17%, 26%, 21% and 6%, respectively (P = .10). Despite a similar incidence of prostate cancer, there is a trend towards more advanced, higher-risk disease in regions 2 and 3. Conclusion(s): Men diagnosed with prostate cancer in South West Victoria have a worse survival compared to the national average. Further, in regions 2 and 3 men present with more advanced disease. Possible causes may include genetic factors, environmental factors or confounding variables. These warrant further study, but increased community awareness and education for general practitioners may be useful.