Urban-rural differences in prostate cancer outcomes in Australia: what has changed?

Objective: To update our previous analysis of trends for prostate-specific antigen (PSA) testing, prostate cancer incidence, radical prostatectomy and prostate cancer mortality to assess whether men in rural and regional areas of Australia now have more equitable access to prostate cancer services, and improved outcomes. Design, setting and participants: Descriptive study using population-based data for Australian men aged 50-79 years from 1982 to the 2008-09 financial year (depending on data availability for each outcome measure). Main outcome measures: Age-standardised rates per 100 000 men and 5-year survival rates. Results: Overall, rates of PSA screening and radical prostatectomy increased, accompanied by reductions in mortality and improvements in survival throughout Australia. Incidence rates were similar for men in urban and rural areas. However, in the last year of data collection, for men in rural areas compared with urban areas, rates of PSA screening (21 267/100000 v 24 606/100000; P < 0.01) and radical prostatectomy (182.2/100000 v 239.2/100000; P < 0.01) remained lower, mortality remained higher (56.9/100000 v 45.8/100000; P < 0.01), and survival outcomes continued to be poorer (5-year relative survival, 87.7% v 91.4%; P < 0.01). Conclusions: With some limitations, these ecological data demonstrate that the use of diagnostic and treatment services among men living in rural areas of Australia remains lower than among their urban counterparts, their survival and mortality outcomes are poorer, and these differentials are continuing. There is an urgent need to explore further the reasons for these differences and to implement changes so these inequalities can be reduced.