Rural‐Urban Differences in Prostate‐Specific Antigen (PSA) Screening and Its Outcomes in New Zealand

Obertová, Zuzana; Hodgson, Fraser; Scott-Jones, Joseph; Brown, Charis; Lawrenson, Ross

doi:10.1111/jrh.12127

Cited by 13 publications

(15 citation statements)

References 23 publications

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“…A moderate quality study from the UK found no differences by urban/rural location in PSA testing (23), while three other (moderate quality) studies reported higher rates of PSA testing among men from urban areas in Australia (31, 32) and New Zealand (33). Consistent with this, urban residents were 10% more likely to have ever had PSA testing and 20% more likely to have been tested within the past 2 years from 1992 to 2012 in Switzerland (30), while men living in regions with higher ratio of specialists to general practitioners (GPs) were around eight times more likely to have PSA testing in Canada (29) (both studies moderate quality).…”

Section: Resultsmentioning

confidence: 95%

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

et al. 2019

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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.

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Section: Resultsmentioning

confidence: 95%

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

et al. 2019

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“…In NZ there was no dedicated PC screening system in place and PSA testing or digital rectal examination or both were undertaken at varying levels (7–41%) by primary care physicians [ 8 ]. Obertova et al reports that 28.7% and 20.7% of men registered with medical practices in urban and rural areas respectively in the Midlands region in NZ were PSA tested in 2010 [ 9 ]. These authors further indicate a gap in being referred to a specialist or getting biopsied for men with elevated PSA levels.…”

Section: Introductionmentioning

confidence: 99%

“…These authors further indicate a gap in being referred to a specialist or getting biopsied for men with elevated PSA levels. The proportion of men with elevated PSA levels that received subsequent biopsies in the Midland region in NZ in 2010 were 22.6% and 29.8% respectively among urban and rural centres [ 9 ]. These authors have noted a significant difference in the proportions of biopsies recorded from urban and rural settings when data were stratified by an age cut off of 70y.…”

Section: Introductionmentioning

confidence: 99%

Influence of lifestyle and genetic variants in the aldo-keto reductase 1C3 rs12529 polymorphism in high-risk prostate cancer detection variability assessed between US and New Zealand cohorts

et al. 2018

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IntroductionThe prostate-specific antigen (PSA) based prostate cancer (PC) screening is currently being debated. The current assessment is to understand the variability of detecting high-risk PC in a NZ cohort in comparison to a US cohort with better PSA screening facilities. Aldo-keto reductase 1C3 (AKR1C3) is known for multiple functions with a potential to regulate subsequent PSA levels. Therefore, we wish to understand the influence of tobacco smoking and the AKR1C3 rs12529 gene polymorphism in this variability.MethodNZ cohort (n = 376) consisted of 94% Caucasians while the US cohort consisted of African Americans (AA), n = 202, and European Americans (EA), n = 232. PSA level, PC grade and stage at diagnosis were collected from hospital databases for assigning high-risk PC status. Tobacco smoking status and the AKR1C3 rs12529 SNP genotype were considered as confounding variables. Variation of the cumulative % high-risk PC (outcome variable) with increasing PSA intervals (exposure factor) was compared between the cohorts using the Kolmogorov-Smirnov test. Comparisons were carried out with and without stratifications made using confounding variables.ResultsNZ cohort has been diagnosed at a significantly higher mean age (66.67± (8.08) y) compared to both AA (62.65±8.17y) and EA (64.83+8.56y); median PSA (NZ 8.90ng/ml compared to AA 6.86ng/ml and EA 5.80ng/ml); and Gleason sum (NZ (7) compared EA (6)) (p<0.05). The cumulative % high-risk PC detection shows NZ cohort with a significantly lower diagnosis rates at PSA levels between >6 - <10ng/ml compared to both US groups (p<0.05). These were further compounded significantly by smoking status and genetics.ConclusionsHigh-risk PCs recorded at higher PSA levels in NZ could be due to factors including lower levels of PSA screening and subsequent specialist referrals for biopsies. These consequences could be pronounced among NZ ever smokers carrying the AKR1C3 rs12529 G alleles making them a group that requires increased PSA screening attention.

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“…(Definitions vary, but metropolitan areas in Australia are within the major capital cities of Sydney, Melbourne, Brisbane, Perth, Adelaide, and Canberra and their suburbs; regional areas are usually taken to be towns and small cities outside the major capital cities; and rural areas are what remain [ 3 , 4 ].) Similarly, men in rural areas in New Zealand were found to be less likely to participate in prostate-specific antigen (PSA) screening and to be diagnosed with prostate cancer at a later stage than men in metropolitan areas [ 5 ]. This disparity is not confined to the southern hemisphere; higher death rates and incidence of late-stage disease, as well as lower prevalence of PSA screening, were found in non-metropolitan areas than metropolitan areas of the United States [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Men’s perceptions of prostate cancer diagnosis and care: insights from qualitative interviews in Victoria, Australia

et al. 2017

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BackgroundThe Victorian Prostate Cancer Registry (Australia) revealed poorer rates of survival for men diagnosed with prostate cancer in one Victorian regional area than for men in metropolitan Melbourne. We sought to explore the perceptions and experiences of prostate cancer diagnosis, treatment, and care of men diagnosed with prostate cancer who lived in regional or metropolitan areas and of men who had not been so diagnosed. Our goal was to contribute to the evidence from which can be built continuing improvements in prostate health care.MethodsUsing the qualitative method of in-depth interviews to gain access to explanation and meaning, we interviewed 21 men: 10 recruited through the Prostate Cancer Outcome Registry-Victoria and 11 from the community. Transcripts were analysed thematically.ResultsWe identified four main themes within which men discussed prostate cancer: Case-finding, Diagnosis, Treatment and Care, and Spreading the Word. Contrasts revealed between regional and metropolitan areas related mostly to the more limited supportive care in regional areas.ConclusionsIt is evident from the perspectives of these men that every aspect of prostate cancer care would benefit from attention: publicising the need to check prostate health, treatment, and supporting men in the years after treatment. Continuing to work on systemic improvements is an important goal for all those committed to men’s health.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3699-1) contains supplementary material, which is available to authorized users.

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Rural‐Urban Differences in Prostate‐Specific Antigen (PSA) Screening and Its Outcomes in New Zealand

Cited by 13 publications

References 23 publications

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

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

Influence of lifestyle and genetic variants in the aldo-keto reductase 1C3 rs12529 polymorphism in high-risk prostate cancer detection variability assessed between US and New Zealand cohorts

Men’s perceptions of prostate cancer diagnosis and care: insights from qualitative interviews in Victoria, Australia

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