Primary management of prostate cancer by universal health coverage effective coverage index

Prostate cancer is under-researched in many Asian countries because the paucity of comprehensive cancer registries has prevented large studies from comparing primary prostate cancer therapies. We aimed to provide further insights into recent trends in primary prostate cancer management across multiple Asian countries and regions according to universal health coverage.

This is part of the Asian Prostate Cancer (A-CaP), a prospective and multicenter study conducted in 12 Asian countries. The study cohort comprised patients newly diagnosed between January 2016 and December 2018. Patients were allocated to three categories according to the universal health coverage effective coverage index (Category 1 ≥ 80; Category 2, 70-79; and Category 3, < 70). We assessed primary management of prostate cancer according to these categories and by clinic pathological characteristics such as clinical stage, and D'Amico risk group.

In total, 34,994 patients were included in the final analysis. Category 1 had the highest proportion of patients diagnosed at early stages and Category 3 had the highest proportion of patients diagnosed at advanced stages. Most patients in Category 1 had undergone computed tomography scans, magnetic resonance imaging, and bone scans. In contrast, only 1.7% and 5.4% of men in Categories 2 and 3, respectively, had undergone all three of these investigations. The proportion of patients who had undergone radiation and androgen deprivation therapy as primary treatment was highest in Category 1, whereas the rate of conservative management was highest in Category 2. More patients in Category 3 than in the other two categories had undergone radical prostatectomy, but fewer had been treated with radiation therapy.

Our findings highlighted differences in patterns of treatment of newly diagnosed prostate cancer across 12 Asian countries and regions and suggest that, despite guidelines, health access affects treatment received.