Background: Socioeconomic status (SES), race, and geographical factors impact prostate cancer management and outcomes. This study assessed these factors in relation to access to novel imaging for prostate cancer.
Methods: Using data from the Prostate Cancer Outcomes Registry of Victoria (PCOR-Vic), the study identified 5256 men diagnosed via biopsy from January 2017 to December 2018. Patients were stratified into pre- and post-subsidisation cohorts based on the introduction of government rebates for multiparametric MRI (mpMRI) on 1 July 2018. The study compared histopathological results and SES and geographical access to mpMRI and PET imaging.
Results:
- Pre-subsidisation cohort: 361 patients; 36.3% underwent pre-biopsy mpMRI.
- Post-subsidisation cohort: 289 patients; 77.5% underwent pre-biopsy mpMRI.
- Positive biopsy rates: Increased from 59.6% (pre-subsidisation) to 68.2% (post-subsidisation).
- Clinically significant PCa: Increased from 39.1% (pre-subsidisation) to 49.5% (post-subsidisation).
- SES gap for MRI access: Reduced from a mean percentile difference of 5.7 (pre-subsidisation) to 3.5 (post-subsidisation).
- SES gap for PET access: Maintained at an average of 9.0 over two years.
- Geographical gap for MRI access: Small, with no large percentage difference (1.6) between metropolitan and regional areas.
- Geographical gap for PET access: Significant difference (8.1), with no improvement over time.
Conclusion:
Access to mpMRI improved for men with lower SES following federal subsidisation, reducing the SES gap.
Access to PET imaging remains limited for lower SES and regional patients due to significant out-of-pocket expenses.
Further improvements are needed for low SES and regional men to access PET staging, especially pending its potential future listing on the Medicare Benefits Scheme.
