Geographic Disparities in Prostate Cancer Outcomes - Review of International Patterns

Background: This study reviewed the published evidence as to how prostate cancer outcomes vary acrossgeographical remoteness and area level disadvantage. Materials and
Methods: A review of the literature publishedfrom January 1998 to January 2014 was undertaken: Medline and CINAHL databases were searched in Februaryto May 2014. The search terms included terms of ‘Prostate cancer’ and ‘prostatic neoplasms’ coupled with ‘ruralhealth’, ‘urban health’, ‘geographic inequalities’, ‘spatial’, ‘socioeconomic’, ‘disadvantage’, ‘health literacy’ or‘health service accessibility’. Outcome specific terms were ‘incidence’, ‘mortality’, ‘prevalence’, ‘survival’, ‘diseaseprogression’, ‘PSA testing’ or ‘PSA screening’, ‘treatment’, ‘treatment complications’ and ‘recurrence’. A furthersearch through internet search engines was conducted to identify any additional relevant published reports.
Results: 91 papers were included in the review. While patterns were sometimes contrasting, the predominatepatterns were for PSA testing to be more common in urban (5 studies out of 6) and affluent areas (2 of 2), higherprostate cancer incidence in urban (12 of 22) and affluent (18 of 20), greater risk of advanced stage prostatecancer in rural (7 of 11) and disadvantaged (8 of 9), higher survival in urban (8 of 13) and affluent (16 of 18),greater access or use of definitive treatment services in urban (6 of 9) and affluent (7 of 7), and higher prostatemortality in rural (10 of 20) and disadvantaged (8 of 16) areas.
Conclusions: Future studies may need to utilise amixed methods approach, in which the quantifiable attributes of the individuals living within areas are measuredalong with the characteristics of the areas themselves, but importantly include a qualitative examination of thelived experience of people within those areas. These studies should be conducted across a range of internationalcountries using consistent measures and incorporate dialogue between clinicians, epidemiologists, policy advocatesand disease control specialists.