Keywords: prostate cancer, primary care interval, care pathway

Background:

Prostate cancer is a common malignant tumour and the most frequent non-cutaneous cancer in men worldwide. It was the fifth leading cause of cancer death in men in 2020. Timely recognition and referral in primary care are crucial.

Research questions:

The study aimed to assess early management of prostate cancer in Slovenian primary care, focusing on the primary care interval and its associations with disease presentation, patient characteristics, regional variation, and healthcare organization. We also examined its association with observed five-year survival.

Method:

The retrospective cohort study included 1,431 patients from the Slovenian Cancer Registry diagnosed with prostate cancer in 2014. Personal physicians extracted data on initial symptoms, diagnostic procedures, referrals, and access to diagnostic services (lab tests, abdominal ultrasound). The primary care interval was calculated from the first presentation (initial contact with relevant symptoms) to referral to a urologist.

Results:

The median duration of the primary care interval was 4 days (IQR: 0–33 days), with an average of 43.9 days (SD: 94.2), range 0-365 days, which is due to the extreme values. Longer intervals were associated with the presence of symptoms at first presentation, but no other statistically significant associations were found. There were no differences between different regions in Slovenia. Primary level interval duration was not associated with shorter observed 5-year survival, but we found an association between shorter observed 5-year survival and lack of direct access to laboratory tests in the primary health centre.

Conclusions:

The study highlights the complex range of factors influencing the management of suspected prostate cancer, including not only the competencies of individual physicians but also the availability of tests and services. Direct access to basic laboratory tests is associated with longer observed 5-year survival and is the only factor among those analysed that we can directly influence, thereby potentially reducing the risk of death.

Points for discussion:

Variation and influencing factors in the primary care interval

Role of diagnostic access in patient outcomes

Limitations of primary care interval as a prognostic indicator