Background: Prostate cancer (PrCa) outcomes are inferior in regional and rural areas compared to metropolitan centres. We evaluated patterns of care in PrCa patients treated in public and private healthcare facilities in regional Tasmania.Methods: This retrospective study used clinicopathological data for 2180 PrCa patients diagnosed between 2015–2022. Descriptive statistics and regression analyses determined associations between treatment facility (public vs. private) and diagnostic and treatment factors.Results: A significantly greater proportion of public patients were from outer regional/remote areas (prevalence ratio (PR) = 1.25, 95% CI: 1.19–1.31), presented with higher-risk disease (PR = 1.56, 95% CI: 1.22–2.00) and underwent active treatment compared to private patients (PR = 1.07, 95% CI: 1.03–1.11). Men treated privately were most likely to have low-risk PrCa (p< 0.001) and be managed with active surveillance (AS, 52.9%). When stratified by disease risk, public patients with intermediate (p< 0.001) or very high-risk/metastatic disease (p= 0.003) were still significantly more likely to receive active treatment than private patients. Furthermore, except for very high-risk/metastatic patients, public patients took significantly longer to commence treatment, ranging between a mean difference of 40 to 59 days depending on risk category.Conclusions: In Tasmania, treatment pathways for PrCa patients differ significantly between public and private healthcare sectors and may contribute to poorer outcomes in regional and remote areas.
背景：与都市中心相比，区域性及农村地区的前列腺癌（PrCa）治疗结局较差。本研究评估了塔斯马尼亚地区公立与私立医疗机构中前列腺癌患者的诊疗模式。 方法：这项回顾性研究纳入了2015年至2022年间确诊的2180例前列腺癌患者的临床病理数据。通过描述性统计与回归分析，探讨了诊疗机构类型（公立与私立）与诊断及治疗因素之间的关联。 结果：与私立机构患者相比，公立机构患者中来自偏远/极偏远地区的比例显著更高（患病比[PR]=1.25，95% CI：1.19–1.31），高危疾病比例更高（PR=1.56，95% CI：1.22–2.00），且接受积极治疗的比例更高（PR=1.07，95% CI：1.03–1.11）。私立机构治疗的患者更可能为低危前列腺癌（p<0.001），并接受主动监测（AS，52.9%）。按疾病风险分层分析显示，中危（p<0.001）或极高危/转移性疾病（p=0.003）的公立患者接受积极治疗的可能性仍显著高于私立患者。此外，除极高危/转移患者外，公立患者开始治疗的时间显著更长，根据风险分层不同，平均延迟时间在40至59天之间。 结论：在塔斯马尼亚地区，前列腺癌患者在公立与私立医疗机构的诊疗路径存在显著差异，这可能是导致区域及偏远地区患者治疗结局较差的原因之一。
肿瘤(癌症)患者之家