The rural disadvantage – prostate cancer outcomes of rural and urban patients over 25 years

Abstract

Purpose

Prostate cancer is a common malignancy among men, with disparities based on the geographic location. This study aims to evaluate long-term trends in prostate cancer outcomes among rural and urban populations within a universal health care system, providing insights into the persistent disparities in cancer-specific mortality despite supposed equal access to medical coverage.

Methods

A retrospective cohort study was conducted using data from the Alberta Cancer Registry (January 1, 1999 to December 31, 2022) and the Alberta Prostate Cancer Research Initiative (APCaRI) (July 1, 2014 to June 7, 2024). There were 45,602,119 person-years from the Alberta Cancer Registry and 8932 men from APCaRI. The exposure was the place of residence, categorized as urban or rural, based on postal codes at the time of diagnosis and death. The primary outcome was prostate cancer-specific mortality.

Findings

Rural men were diagnosed at an older age (66.7 vs. 68.9, p<0.001) and had higher age-adjusted prostate cancer-specific mortality compared to urban men (52.0 vs. 37.6 deaths per 100,000, p<0.001). Though both groups showed improvements over time, rural areas consistently had higher age-adjusted mortality rates. Despite a 38% relative increase in prostate cancer specific mortality, rural patients had minimal, though statistically significant differences in PSA (9% vs. 11% >20, p = 0.008), stage (40% vs. 46% T2–T4, p<0.001) and Gleason Grade Group (11% vs. 14% ≥4, p<0.001) at diagnosis.

Conclusions

The study reveals that rural men experienced significantly worse prostate cancer outcomes compared to urban men. These findings highlight the need for targeted health care interventions to improve access to care in rural areas.