Clinical intervals and diagnostic characteristics in a cohort of prostate cancer patients in Spain: a multicentre observational study

Abstract

BackgroundLittle is known about the healthcare process for patients with prostate cancer, mainly because hospital-based data are not routinely published. The main objective of this study was to determine the clinical characteristics of prostate cancer patients, the, diagnostic process and the factors that might influence intervals from consultation to diagnosis and from diagnosis to treatment.MethodsWe conducted a multicentre, cohort study in seven hospitals in Spain. Patients’ characteristics and diagnostic and therapeutic variables were obtained from hospital records and patients’ structured interviews from October 2010 to September 2011. We used a multilevel logistic regression model to examine the association between patient care intervals and various variables influencing these intervals (age, BMI, educational level, ECOG, first specialist consultation, tumour stage, PSA, Gleason score, and presence of symptoms) and calculated the odds ratio (OR) and the interquartile range (IQR). To estimate the random inter-hospital variability, we used the median odds ratio (MOR).Results470 patients with prostate cancer were included. Mean age was 67.8 (SD: 7.6) years and 75.4 % were physically active. Tumour size was classified as T1 in 41.0 % and as T2 in 40 % of patients, their median Gleason score was 6.0 (IQR:1.0), and 36.1 % had low risk cancer according to the D’Amico classification. The median interval between first consultation and diagnosis was 89 days (IQR:123.5) with no statistically significant variability between centres. Presence of symptoms was associated with a significantly longer interval between first consultation and diagnosis than no symptoms (OR:1.93, 95%CI 1.29–2.89). The median time between diagnosis and first treatment (therapeutic interval) was 75.0 days (IQR:78.0) and significant variability between centres was found (MOR:2.16, 95%CI 1.45–4.87). This interval was shorter in patients with a high PSA value (p = 0.012) and a high Gleason score (p = 0.026).ConclusionsMost incident prostate cancer patients in Spain are diagnosed at an early stage of an adenocarcinoma. The period to complete the diagnostic process is approximately three months whereas the therapeutic intervals vary among centres and are shorter for patients with a worse prognosis. The presence of prostatic symptoms, PSA level, and Gleason score influence all the clinical intervals differently.

Clinical interval and diagnostic characteristics in a cohort of bladder cancer patients in Spain: a multicenter observational study

“…We performed a multicenter, cohort study of bladder and prostate cancer, in Spain [ 11 ]. The research ethics committee from each of the seven tertiary participating hospitals (Additional file 1 ) approved the protocol.…”

Associação de variáveis sociodemográficas e clínicas com os tempos para início do tratamento do câncer de próstata

“…In Canada 9 , a research revealed that from the diagnosis to the start of radiotherapy, intermediate-and high-risk men had a shorter waiting time when compared to those at low risk. As in Spain 20 , men with high PSA and high Gleason score obtained a lower interval between diagnosis and treatment.…”

“…In the two US studies cited above 12,13 , both found that black men were younger, had lower income and with a lower educational level when compared to whites. However, a Spanish study 20 did not find an association between the time elapsed from the diagnosis to the first treatment with the educational level. Although inequalities by schooling level in the use of health services are decreasing consistently in Brazil 19 , it is still a huge challenge.…”

Demora en el diagnóstico y tratamiento de 5 tipos de cáncer en 2 centros de salud urbanos

“…En el cáncer de próstata ocurre también que muchos pacientes tienen síntomas urinarios de larga evolución por hipertrofia benigna y resulta difícil determinar en qué momento atribuirlos al cáncer. Esto coincide con trabajos anteriores 9 , 25 .…”

“…En el realizado por el grupo ICBP en 2018, las medianas para el CCR oscilaron entre 27 y 76 días 19 y para el pulmón entre 25 y 45 18 . En el estudio de Bonfill et al, el tiempo invertido en el diagnóstico desde la consulta de urología tiene una mediana de 89 días en próstata 25 y 104 en vejiga 30 .…”