GU cancer

Prostate cancer: new findings on private treatment and long term outcomes

Men with localised prostate cancer are more likely to receive radical treatment if they use private health services than men treated in the public system, a Victorian study shows.

A review of Victorian Cancer Registry data for more than 29,000 men diagnosed with prostate cancer during 2011–2017 found that those treated in privately were significantly more likely to have radical prostatectomy and less likely to have radiation therapy compared to men treated in public hospitals.

The findings from a Cancer Council Victoria study published by the MJA showed that after adjusting for age, tumour classification and comorbidity, men diagnosed in private health services received radical treatment more frequently than men diagnosed in public health services (odds ratio [OR], 1.40).

The proportion of private patients who underwent radical prostatectomy was larger than that for public patients (44% v 28%, OR 2.28) and the proportion of private patients who received curative external beam radiation therapy alone (excluding brachytherapy) was smaller (9% v 19%, OR 0.45).

The difference for prostatectomy was greater for men diagnosed after the age of 70 years (private v public: OR, 3.45) than for younger men (OR, 1.96), whereas for radiation therapy alone, it was larger for those diagnosed before age 70.

The study authors noted that in an era of widespread PSA testing, an increasing number of men are being diagnosed with localised prostate cancer and undergoing active treatment, even though two prospective randomised trials have found no difference in prostate-specific and overall survival outcomes for surgery, radiation therapy, and watchful waiting.

They said it was not possible to identify which factors influenced the differences in treatment chosen for men with localised prostate cancer in private and public healthcare, and more research is needed.

“Treatment of people with cancer should be consistent, safe, of high quality and evidence-based, as described in the Cancer Council optimal care pathway for men with prostate cancer,” they concluded.

Meanwhile, a separate study has found that Australian men with localised prostate cancer treated with radical prostatectomy have poor outcomes for quality of life, particularly in relation to long term sexual outcomes.

The 15-year follow up of 1642 NSW men aged less than 70 found that levels of erectile dysfunction were 62%  for active surveillance/watchful waiting and 83%  for non-nerve sparing radical prostatectomy compared with 43% for a control group.

Men who had external beam radiation therapy or high dose rate brachytherapy or androgen deprivation therapy as primary treatment reported more bowel problems.

Urinary incontinence was particularly prevalent and persistent for men who underwent surgery, and an increase in urinary bother was reported in the group receiving androgen deprivation therapy.

“Given the relatively high 15 year survival rate for men with localised prostate cancer, and the comparable mortality rates across treatment groups for men with low risk disease, the longitudinal quality of life changes discussed in this study are becoming vitally important to consider,” said the study authors from Cancer Council NSW, in the BMJ.

“Men diagnosed with localised prostate cancer have previously expressed a need for more involvement in treatment decision making, while also finding the many treatment options confusing or distressing, resulting in uncertainty over the best choice for them.”

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