Geographical Variations in Prostate Cancer Outcomes: A Systematic Review of International Evidence

Abstract

Background: Previous reviews of geographical disparities in the prostate cancer continuum from diagnosis to mortality have identified a consistent pattern of poorer outcomes with increasing residential disadvantage and for rural residents. However, there are no contemporary, systematic reviews summarizing the latest available evidence. Our objective was to systematically review the published international evidence for geographical variations in prostate cancer indicators by residential rurality and disadvantage. Methods: Systematic searches of peer-reviewed articles in English published from 1/1/1998 to 30/06/2018 using PubMed, EMBASE, CINAHL, and Informit databases. Inclusion criteria were: population was adult prostate cancer patients; outcome measure was PSA testing, prostate cancer incidence, stage at diagnosis, access to and use of services, survival, and prostate cancer mortality with quantitative results by residential rurality and/or disadvantage. Studies were critically appraised using a modified Newcastle-Ottawa Scale. Results: Overall 169 studies met the inclusion criteria. Around 50% were assessed as high quality and 50% moderate. Men from disadvantaged areas had consistently lower prostate-specific antigen (PSA) testing and prostate cancer incidence, poorer survival, more advanced disease and a trend toward higher mortality. Although less consistent, predominant patterns by rurality were lower PSA testing, prostate cancer incidence and survival, but higher stage disease and mortality among rural men. Both geographical measures were associated with variations in access and use of prostate cancer-related services for low to high risk disease. Conclusions: This review found substantial evidence that prostate cancer indicators varied by residential location across diverse populations and geographies. While wide variations in study design limited comparisons across studies, our review indicated that internationally, men living in disadvantaged areas, and to a lesser extent more rural areas, face a greater prostate cancer burden. This review highlights the need for a better understanding of the complex social, environmental, and behavioral reasons for these variations, recognizing that, while important, geographical access is not the only issue. Implementing research strategies to help identify these processes and to better understand the central role of disadvantage to variations in health outcome are crucial to inform the development of evidence-based targeted interventions.

Use of empiric methods to inform prostate cancer health disparities: Comparison of neighborhood‐wide association study “hits” in black and white men

“…US Census variables generally are highly collinear and, by design, the NWAS method only selects 1 variable from each group of highly interrelated variables. In addition, the frequency or percentages of census variables may vary, not only by race (see Supporting Table 1), but also by geographic location and the geographic boundary selected as the unit of study (eg, county vs census tract) . Furthermore, due to the smaller sample size in the black population, we may have lacked statistical power with which to validate the 17 hits from the white NWAS.…”

Contemporary consumer perspectives on prostate cancer survivorship: Fifty voices

“…Nevertheless, these perspectives may not match priorities for men with prostate cancer from low‐ and middle‐income countries, or those with markedly different health systems to that in the present study. We were however able to recruit men from regional and rural Australia and this speaks to the consideration of the poorer disease outcomes that are prevalent in these geographic areas …”

“…We were however able to recruit men from regional and rural Australia and this speaks to the consideration of the poorer disease outcomes that are prevalent in these geographic areas. 36…”

Using Prostatic Fluid Levels of Some Trace Elements and Their Combinations in Non-Invasive and Highly Accurate Screening for Prostate Cancer

“…Worldwide, PCa is the second most commonly diagnosed cancer and the fifth leading cause of cancer deaths in men [1]. PCa is especially prevalent in industrialized countries including North America, Northern and Western Europe and Australia [2]. The American Cancer Society declares PCa, with a lifetime prevalence of one in six men, is the most common cancer in males and the second leading cause of cancer death [3].…”

“…The American Cancer Society declares PCa, with a lifetime prevalence of one in six men, is the most common cancer in males and the second leading cause of cancer death [3]. Moreover, PCa is the leading cancer in terms of incidence and mortality in men from Africa, Oceania, and the Caribbean [1] [2]. PCa in China has also become a major public health concern [4].…”