Patterns of Presentation of Prostate Cancer in Patients of Non-English-Speaking Background at an Australian Institution-A 6-Year Retrospective Study.

Abstract

Background: Patients originating from culturally and linguistically diverse (CALD) backgrounds and lacking English proficiency often experience poorer health outcomes within Australia. This study aimed to determine whether patients of non-English speaking background (NESB) are more likely to be diagnosed with higher-grade prostate cancer on biopsy, and whether their NESB status affects treatment.

Methods: A retrospective review was conducted of all patients diagnosed with prostate cancer on transperineal biopsy and followed up at Western Health in Melbourne, Australia from January 2016 to December 2022. Patients who were not followed up at our institution were excluded. Nonparametric testing and propensity score matching in a 1:1 ratio were used to evaluate differences in disease characteristics and treatments between NESB and English-speaking patients. The need for an interpreter during medical consultations was used to classify patients as non-English-speaking.

Results: We identified 779 patients who were diagnosed with prostate cancer. Within this group, 136 (17.5%) were non-English-speaking and required an interpreter. The median PSA (ng/mL) and PSA density (ng/mL/cc) pre-biopsy were 9.9 (IQR: 6.7-15.0) and 0.23 (0.15-0.46) respectively, in the NESB group, and 7.4 (5.2-12.3) and 0.19 (0.12-0.31) respectively, in the English-speaking group (p < 0.001). A greater proportion of men of NESB were diagnosed with higher-grade prostate cancer on biopsy compared with their English-speaking counterparts (p < 0.001). When we controlled for pre-biopsy prostate cancer grade, there was no statistical difference in the proportion of patients managed with radical prostatectomy (p = 0.977), radiotherapy (p = 0.544), ADT (p = 0.113) or chemotherapy (p = 0.792).

Conclusion: NESB men are more likely to be diagnosed with higher-grade prostate cancer on biopsy compared with their English-speaking counterparts due to delayed presentation. Language is not seen as a barrier to receiving appropriate treatment for their prostate cancer. Further studies with more granular data pertaining to cancer staging, sequence of treatments and oncological outcomes are required to ascertain the effectiveness of care delivery towards NESB patients living with prostate cancer.