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Prostate cancer outcomes and delays in care

  • Urology - Original Paper
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Abstract

Objectives

To examine the survival effect of treatment delays from the time of confirmed diagnosis of prostate cancer to first treatment in an Australian population.

Methods

Three thousand one hundred and forty patients were identified from the South Australian Prostate Cancer Clinical Outcomes Collaborative database for analysis. Selected patients had dates recorded for both diagnosis and treatment. We examined the effect of treatment delay (the time from diagnosis to date of first treatment) on survival using Cox and competing risks regression and compared quartiles of delay across the cohort. Adjustment was made for age, PSA levels, treatment modality and Gleason score. Outcomes included overall survival (OS) and prostate cancer-specific mortality (PCSM).

Results

Quartiles of delay were as follows (days)—Q1: 35, Q2: 86, Q3: 138.0, Q4: 264. Shorter delays were associated with hormonal treatment, high Gleason score and high PSA values. Measuring PCSM with Q2 as reference, age-adjusted associations were—Q1: sHR 4.37 (2.75–6.94), Q3: sHR 1.29 (0.73–2.28), Q4: sHR 1.55 (0.91–2.63). After additional adjustment for treatment type, Gleason score and PSA, Q1 remained at increased risk [sHR 2.46 (1.10–5.54)]. A similar trend was observed for OS. In analysis stratified by Gleason score, delays were not significantly associated with OS.

Conclusions

Factors associated with shorter delay in treatment include high Gleason score, high PSA and hormonal treatment. After adjustment for these variables, increased delays were not associated with OS or PCSM in this cohort. The nonlinear association of delay with risk may explain conflicting reports in the literature.

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Abbreviations

PSA:

Prostate-specific antigen

CI:

Confidence interval

HR:

Hazards ratio

SA-PCCOC:

South Australian Prostate Cancer Clinical Outcomes Collaborative

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Acknowledgements

We gratefully acknowledge all men enrolled in the SA-PCCOC database together with clinical contributors and funders. SA-PCCOC received funding from: the Movember Foundation, Urological Society of Australia and New Zealand, Tolmar Australia, Ipsen, Ferring, the Beat Cancer Initiative and The Hospital Research Foundation. No funding source influenced the preparation of this manuscript.

Funding

This study was funded by the Flinders Centre for Innovation in Cancer (FCIC), Flinders University of South Australia (Grant No. RPF12/243).

Author information

Authors and Affiliations

  1. Urology Unit, SA Health, Repatriation General Hospital, Daws Road, Daw Park, Adelaide, SA, 5041, Australia

    Michael E. O’Callaghan & Tina Kopsaftis

  2. South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC), Adelaide, SA, Australia

    Michael E. O’Callaghan, Tina Kopsaftis & Kim Moretti

  3. Discipline of Medicine, Freemasons Foundation Centre for Men’s Health, University of Adelaide, Adelaide, SA, Australia

    Michael E. O’Callaghan & Kim Moretti

  4. Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, Adelaide, SA, Australia

    Michael E. O’Callaghan

  5. Population Research and Outcome Studies, School of Medicine, University of Adelaide, Adelaide, SA, Australia

    Zumin Shi

  6. Department of Surgery, Flinders University of South Australia, Bedford Park, Adelaide, SA, Australia

    Kim Moretti

  7. Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia

    Kim Moretti

  8. School of Population Health, University of South Australia, Adelaide, SA, Australia

    Kim Moretti

  9. Urology Unit, SA Health, The Queen Elizabeth Hospital, Adelaide, SA, Australia

    Kim Moretti

Authors
  1. Michael E. O’Callaghan
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  2. Zumin Shi
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Corresponding author

Correspondence to Michael E. O’Callaghan.

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All authors declare that he/she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent or ethics committee approved opt-out consent was obtained from all individual participants included in the study.

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O’Callaghan, M.E., Shi, Z., Kopsaftis, T. et al. Prostate cancer outcomes and delays in care. Int Urol Nephrol 49, 449–455 (2017). https://doi.org/10.1007/s11255-017-1508-z

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  • DOI: https://doi.org/10.1007/s11255-017-1508-z

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