Patterns of prostate‐specific antigen testing by remoteness of residence and socio‐economic status: An Australian population‐based study

Abstract

Objective: Describes the variation in prostate cancer testing by the remoteness of residence and socio-economic status groups in Australia. Design: A national population-based descriptive study using Medicare data extracted by the Department of Health (formerly the Department of Health and Ageing). Setting: Australia.Participants: All men, with a Medicare-reimbursed prostate-specific antigen test conducted in Australia between 2002 and 2017, were included. We focused on "screening and case finding" tests (Medicare Benefits Schedule item number 66655) from 1 April 2005 to 31 December 2009, to describe testing differences in subgroups. Groups were categorised into State and Territory, socio-economic status and region of residence. A negative binomial regression model was fitted to measure the incidence rate ratios of those who had a screening prostate-specific antigen test by group. Main outcome measures: Age-standardised testing rates and incidence rate ratios. Results: Between 2002 and 2017, 11 588 775 screening prostate-specific antigen tests were reimbursed by the Department of Human Services. During 2005-2009, 52% of all Australian men, aged 40 years and over, had a screening test. The incidence rate ratios differed by State and Territory. Men aged 40 years and over, living in very remote areas, were 43% less likely to have had a screening test than residents of major cities. Prostate-specific antigen testing rates fell in all age groups between 2007 and 2009 and 2017. Conclusions:The prostate-specific antigen testing behaviour differs between community groups in Australia. Men were less likely to have had a screening prostatespecific antigen test the farther they lived from the major cities. This highlights the need for a more targeted approach to achieve an equitable and evidence-based prostate cancer care across all sectors of the community. K E Y W O R D SAustralia, prostate cancer, prostate-specific antigen test, screening

Detection of clinically significant cancer in the anterior prostate by transperineal biopsy

“…Possible reasons for higher detection rates of cancer in our present TP biopsy study compared to published TRUS biopsy data include a higher number of cores taken and inclusion of other biopsy indications such as abnormal DRE. Additionally, a higher detection rate in our present cohort from a regional city could reflect a geographic or socioeconomic disparity in the incidence of prostate cancer [19,20].…”

Urban–rural prostate cancer disparities in a regional state of Australia

“…This is not surprising given that PrCa patients from outer regional/remote areas were significantly more likely to reside in areas with lower rates of socio-economic advantage, which may inhibit their access to healthcare, including regular screening check-ups. Another possible factor contributing to the higher rates of advanced disease diagnosed amongst this cohort could be the higher PSA monitoring rates seen in metropolitan regions of Australia and New Zealand compared to rural regions 2 , 7 , 8 . As a rise in PSA is one of the few strategies for early detection of PrCa, limited access to this testing could result in the delay of diagnosis until the disease becomes symptomatic.…”

“…These individuals presented with significantly higher prostate-specific antigen (PSA) levels and Gleason scores at diagnosis and also experienced a prominent delay between diagnosis and the commencement of treatment 5 , a factor that could adversely affect outcomes 6 . Furthermore, a nationwide study in 2005 identified 29% lower rates of radical prostatectomy in outer regional and rural areas 3 , and though regular PSA testing is undertaken across Australia, it is more common in capital cities 3 and less in regional and remote areas 7 . A New Zealand study has reported similar discrepancies between rates of PSA screening and men living in rural or urban regions 8 .…”

Implications of a new element in the early diagnostic pathway for prostate cancer for rural Australians

“…This holds true for prostate cancer, with lower uptake of diagnostic and treatment services and worse mortality among rural men 12 . PSA screening and radical prostatectomy rates are lowest among rural men and while survival rates for prostate cancer in Australia are among the highest in the world; in Australia, prostate cancer survival is worst for rural men 11‐13 …”