Closing the gap of prostate cancer presentation disparities in Ireland

Recent findings from a study on prostate cancer in Ireland reveal diagnosis disparities, especially in urban areas and middle socioeconomic groups. Patients treated in public hospitals and urban patients were more often diagnosed through opportunistic screenings. 

This recent study characterised disease presentation features, identified factors related to socio-demographic disparities in presentation following opportunistic screening, and shed light on potential inequality challenges within Ireland’s healthcare structure. Addressing these gaps in the healthcare system may guide future strategies for equitable early detection.

Prostate cancer is the most commonly diagnosed cancer in men in Ireland. It accounts for almost 30% of total cancer cases in men. There were 3,980 cases diagnosed on average each year from 2019 to 2021 (source: National Cancer Registry of Ireland). This translates to a 1 in 9 (11%) risk of developing prostate cancer before the age of 75. 

Early detection of prostate cancer is crucial for improving outcomes and survival rates. The Irish Prostate Cancer Outcomes Research (IPCOR) team led by Associate Clinical Professor David Galvin, UCD School of Medicine, Mater & St Vincent Hospitals, supported by the Irish Cancer Society and the Movember Foundation, is focused on improving prostate cancer care in Ireland by creating a comprehensive national database, assessing care quality, and evaluating patient experiences. 

To do this, the IPCOR project collected data on demographics, diagnosis, and treatment of 6,816 men newly diagnosed with prostate cancer across 16 hospitals in the Republic of Ireland from February 2016 to January 2020. These men were seen in the urology clinic after opportunistic screening. 

Opportunistic screening for prostate cancer refers to the practice of testing for the disease (usually by a blood test called a PSA test) in men who visit healthcare providers for unrelated reasons. It does not refer to testing following clinical findings and or as part of a screening programme. Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in the blood. 

IPCOR team (L-R): Associate Clinical Professor David Galvin, Mater & St Vincent Hospitals (PI); Dr Wasfa Farooq, Research Project Manager:; Professor William Watson, UCD School of Medicine & UCD Conway Institute (Co-PI); Dr Noa Gordon, Newman Fellow. 

This study provides a comprehensive national-level analysis of prostate cancer presentation disparities in Ireland, covering both rural and urban populations and public versus private healthcare sectors. 

The type of hospital was a key determinant in attending the urology clinic after opportunistic screening. Patients in public hospitals are 45.7% more likely to be presented following screening compared to those in private hospitals. 

Urban residents were 34% more likely to present following screening than rural ones. However, patients in urban areas are diagnosed with more advanced prostate cancer. One possible explanation for this is that urban healthcare systems are burdened by longer wait times, particularly in the public sector, leading to delays in both diagnosis and treatment.  

The findings highlight the impact of healthcare access inequalities, particularly for middle socioeconomic groups and rural populations, on prostate cancer presentation following opportunistic screening. They point to the need for targeted interventions to improve healthcare access, offering actionable insights for policymakers and healthcare providers.

Commenting on the study, Professor David Galvin said, “By addressing these nuanced differences in access to healthcare, socioeconomic status, and urban versus rural residence in addition to implementing tailored strategies, we can work towards closing disparity gaps in prostate cancer care, ultimately leading to improved health outcomes and equity across all population segments".

Co-investigator and Conway Fellow, Professor William Watson from UCD School of Medicine added, "This study contributes to the broader global discussion on healthcare equity in cancer detection, particularly in countries with mixed public-private healthcare systems, such as Ireland.”

Dr Noa Gordon is part of the IPCOR team and  carried out this research as part of her Janssen-Movember Newman Postdoctoral Fellowship.

Journal Reference    
Gordon, N., Dooley, C., Murphy, Á. et al. Are we there yet? Closing the gap of prostate cancer presentation disparities in Ireland. Arch Public Health 82, 210 (2024).