The effect of prostate cancer center proximity on patient outcomes and treatment type selection
Waleed Shabana1, Vahid Mehrnoush1, Neda Ghaffari-Marandi1, Kristi Dolcetti1, Hazem Elmansy1, Kevin Ramchandar1, Edwin Long1, Ahmed Zakaria1, Ahmed Kotb1, Walid Shahrour1.
1Northern Ontario School of Medicine, Thunder Bay, ON, Canada
Introduction: Access to a cancer center and a urology service may be critical for diagnosing and managing prostate cancer while it is still curable. The purpose of this study is to determine the relationship between proximity to the cancer center to presentation and treatment selection.
Methods: Between 2010 and 2017, a cohort of 959 patients diagnosed with prostate cancer was retrospectively reviewed. The baseline demographics, postal code, round trip time to the cancer center, clinical staging, prostate-specific antigen (PSA) at diagnosis, pathological data obtained during biopsy, staging investigations, selected treatment option, and followup data were reported. The cohort was divided into two groups: those living above and those living below 300 km from our center. The distance between the patient's home and the hospital, as well as the clinical stage, Gleason score, PSA, pathological staging, and treatment modality selected, were statistically analyzed.
Results: The mean distance from patient residence to hospital was 115.7 km. There was a significant correlation between PSA at diagnosis and distance to the hospital (p<0.001, Correlation coefficient=0.16). The median PSA at diagnosis was 8.8 ng/dl vs. 13.6 ng/dl between patient group ≤300 km compared to patient group >300 km. The percentage of Gleason 6 patients was significantly lower in the group that lived >300 km (13.6% vs. 21.4%, p=0.002). The initial diagnosis of metastatic prostate cancer was found to be significantly higher in the group that lived >300 km from the treatment center (22.3% vs.15.3%, p=0.02). The choice of radical prostatectomy as a treatment modality was found to be significantly higher in the group that lived >300 km away from the treatment center (69.9% vs. 54.4%, p=0.0005).
Conclusions: Distance from urologists and cancer centers plays a significant role in the presentation and treatment of prostate cancer. PSA was found to increase for every km the patient is away from the urologist. Distance was a factor in the choice of radical prostatectomy compared to radiation, likely secondary to the reduction in travelling.
