Sociodemographic landscape of suspected prostate cancer referrals and diagnoses across North East London

Abstract

Objectives

The objective of this study is to identify healthcare inequities in referrals and diagnoses of suspected prostate cancer (PCa) in an ethnically diverse and socially deprived large urban region.

Methods

Retrospective cohort study of 2-Week Wait (2WW) suspected PCa patients (n = 12 947) referred to two acute NHS Trusts in North East London (NEL) from February 2019 to August 2023. Sociodemographics, diagnosis and pretreatment staging data were collected from patient records. We examined referral and diagnosis statistics, age at referral, radiological T-stage at diagnosis, levels of deprivation by ethnicity and the impact of COVID-19 pandemic lockdowns on proportion of referrals and diagnoses by ethnicity and T-stage at diagnosis. Uni- and multivariable logistic regression was performed to identify predictors of locally advanced (T-stage ≥T3) disease.

Results

Of all referrals, 22% were diagnosed with PCa. There were no statistically significant differences in referrals, diagnoses or T-stage of PCa by ethnicity during COVID lockdown versus non-lockdown periods (p > 0.05). Compared to men from any other ethnicity, Black men (from Black British, Black African and Black Caribbean ethnic groups) were diagnosed at a younger age (mean = 65 years), had the highest age-adjusted PCa incidence rate of 149 per 100 000 person-years, were from the most deprived backgrounds, and were diagnosed with the highest proportion of localised PCa (74%). Multivariable analysis of a patient subgroup revealed age bands 71–80 years (OR 2.01, 95% CI 1.31–3.07) and >80 (OR 4.27, 95% CI 2.25–8.08) as independent positive predictors of locally advanced PCa, and Black ethnicity as an independent predictor of localised disease (OR 0.66, 95% CI 0.43–1.00). Limitations of this study include the exclusion of PCa cases diagnosed outside the 2WW pathway, as well as missing data on Prostate-Specific Antigen (PSA) levels, distant radiological staging and histopathological findings.

Conclusion

We identify disparities in PCa incidence, stage and age at presentation, as well as socio-economic deprivation among Black men in NEL. Targeted efforts are needed to mitigate these healthcare inequities.