Patterns of surgical care for prostate cancer in NSW, 1993-2002: rural/urban and socio-economic variation

Objectives: Prostate cancer is the most commonly registered cancer in Australian men, yet there is a lack of information about its management. We described the patterns and trends in the surgical treatment of men with prostate cancer in New South Wales (NSW). Method: We used probabilistic record linkage to link cancer registry data with hospital admissions. All NSW men diagnosed with prostate cancer between 1993 and 2002 were eligible for the study. Rates of radical prostatectomy, bilateral orchidectomy and transurethral resection of the prostate were calculated. Factors affecting the probability of undergoing these procedures were examined using log-binomial regression. Results: Between January 1993 and December 2002, 38,712 men were diagnosed with prostate cancer in NSW. Of these, 33,200 (85.8%) cancer registry records were linked to at least one hospital admission record. Men resident in rural areas at diagnosis (RR = 0.69, 95% Cl 0.65-0.73) and men resident in more socio-economically disadvantaged areas (RR =0.83, 95% Cl 0.78-0.89 for most disadvantaged) were significantly less likely to undergo a radical prostatectomy after adjusting for age and disease stage. While orchidectomy rates fell significantly during the period, rates were significantly higher in rural and lower socio-economic areas after adjusting for age and stage. Conclusion and implications: Further investigation is needed to understand the reasons for the variation in the surgical patterns of care for prostate cancer so that interventions can be implemented to ensure appropriate access for all men.