Objective: The objective of this article is to identify whether there is a difference in survival from prostate cancer in urban and rural areas of Scotland and to identify potential inequalities in incidence, disease characteristics and the treatment of prostate cancer between these areas.
Subjects/patients and methods: A retrospective cohort study was undertaken. Retrospective analysis of data from Information Services Division and regional cancer databases from 2005 to 2010 was performed. A comparison of NHS Highland & Western Isles as the rural group with NHS Lothian as the urban group was made. Data were collected on patient and disease characteristics, first treatment and mortality. Non-parametric continuous data were analysed using the Mann-Whitney U test. Categorical data were assessed using a two-tailed Z test. The p value for statistical significance was set at <0.05.
Results: The incidence of prostate cancer was higher in rural areas. Rural patients were older at diagnosis (p <0.0001), presented with higher risk disease (p <0.0001) and underwent less curative treatment (p <0.0001). There was potentially poorer survival in rural areas.
Conclusions: Men living in rural areas of Scotland present with more aggressive prostate cancer and may have poorer survival. This could be due to high levels of PSA testing in urban areas, therefore further studies are needed to identify patterns of PSA testing in Scotland. These inequalities will be highlighted to the Scottish Government to inform the 'Detect Cancer Early' campaign for its second phase in 2015.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
The authors would like to thank Emma Tasker (Cancer Auditor, NOSCAN) and Lauren Aitken (Urology audit facilitator, SCAN) for providing data from their respective cancer network databases; Mr Satchi Swami (Consultant Urological Surgeon, Aberdeen Royal Infirmary) and Mr Prasad Bolina (Consultant Urological Surgeon, Western General Hospital, Edinburgh) for authorising the release of data; and Paula McCelland from ISD for her assistance with the request for ISD data.
- disease characteristics
- Prostate cancer