Differences in patterns of care of prostate cancer, New South Wales, 1991

In this time of uncertainty about the benefits of earlier diagnosis for prostate cancer and the optimal choice of treatment in various clinical scenarios, we addressed the hypothesis that two groups in the population, namely country dwellers and migrants from non-English-speaking countries, were less likely to be offered new methods of diagnosis and treatment for prostate cancer.

Incident cases of prostate cancer in 1991 were identified through the population-based New South Wales Central Cancer Registry. For 73% of eligible cases information relating to diagnosis, staging and treatment was abstracted onto a checklist from clinical records in urologists' consulting rooms and in public hospitals.

Transrectal ultrasound and prostatic biopsy were used for diagnosis significantly more often in urban than in rural cases while the reverse was true for transurethral resection of the prostate. Intravenous pyelography, ultrasound (other than transrectal) and bone scans were performed for staging more frequently in urban than rural cases. Rural cases were more likely to be treated with anti-androgens than urban cases and less likely to be given luteinizing-hormone releasing hormone (LH-RH) agonists. The pattern of use of various diagnostic and staging procedures for 1991 rural cases resembled that for urban men diagnosed with prostate cancer in 1986 rather than that for 1991 urban cases.

At least in part, these urban-rural differences could be explained by the fact that some patients in the country would have been treated by general surgeons rather than urologists. The patterns of care for non-English-speaking migrants resembled those for the Australian-born and for English-speaking migrants.