We reported previously (Jong et al, MJA 2004) that men in rural and remote NSW had lower survival from prostate cancer compared to their metropolitan counterparts. In this study, we used recent data to examine geographical differences in survival from prostate cancer by stage of disease at diagnosis to identify perceived disparities in access to diagnostic and treatment services between geographical areas.
We obtained data from the NSW Central Cancer Registry for all first primary prostate cancer cases diagnosed in 1999-2007. Stage was classified as localised, non-localised or ‘unknown’. Place of residence at diagnosis was categorised as major cities, inner regional, rural (including outer regional, remote and very remote) using ARIA+. We estimated cause-specific survival and used Cox proportional hazards models to adjust for other factors.
Over 90% of prostate cancer patients were diagnosed with localised (48.5%) or “unknown” (41.8%) stage disease. Compared with men in major cities, those living in inner regional and rural areas had poorer overall 8-year survival (83.5%, 79.6%, and 79.4% respectively), a higher proportion with “unknown” stage (40.0%, 45.2%, and 45.3% respectively) and a lower proportion with localised stage disease (50.2%, 45.4%, and 44.3% respectively). After adjusting for age and year of diagnosis, and stage of disease, the risk of dying from prostate cancer was significantly higher for cases in inner regional (Hazard Ratio=1.24, 95% CI: 1.15-1.33) and rural areas (1.17, 1.04-1.31).
Recent data indicate that geographical inequities in prostate cancer survival still persist in NSW: those living in areas outside major cites had poorer survival. This finding in combination with a larger proportion having ‘unknown’ stage recorded in the Cancer Registry suggests that prostate cancer patients living in inner regional and rural NSW may have poorer access to specialist healthcare services compared with their counterparts living in major cities.