Delays in prostate cancer care within a hospital network in Victoria, Australia

To characterize and identify interval delays for patients referred to a tertiary hospital with prostate-specific antigen (PSA) elevation, as delays in prostate cancer diagnosis may result in worse outcomes.

We retrospectively reviewed consecutive referrals to our urology unit for abnormal PSA assessments, over a 24-month period. Demographics, PSA measurements, clinical staging, biopsy grade and treatment were recorded. Referral, review, biopsy and treatment intervals were calculated. Associations were analysed using Wilcoxon rank-sum tests.

Two hundred and thirty men were included, with median age 65 years and PSA 7.6 ng/mL at referral, of whom 197 (85.7%) men had cancer on biopsy. The median referral, review, biopsy and treatment intervals were 8.1 (range 0.1-109.9), 1.7 (0.1-19.4), 1.9 (0.0-31.5) and 1.9 (0.2-17.3) months respectively. One hundred and seven patients (56.6%) had more than one abnormal PSA prior to referral. Eighty-five (60.7%) patients had referral delay ≥3 months, and were found to be: older (66 versus 63 years, P = 0.02), less likely to have family history (12 versus 24%, P = 0.07) and have a prior abnormal PSA (93 versus 0%, P < 0.0001). Treatment intervals ≥1 month occurred in 104 (70.3%) patients, associated with higher clinical stage (P = 0.0002) and biopsy grade (P < 0.0001).

Our results indicate frequent referral delays, which in some cases may be reflective of older age or a lower risk profile. However, treatment delays are associated with higher risk disease, possibly reflecting time needed for staging and treatment discussions. Further efforts are needed to optimize timely referral, investigation and treatment of men with elevated PSA.