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01.12.2015 | Research | Ausgabe 1/2015 Open Access

BMC Urology 1/2015

Clinical intervals and diagnostic characteristics in a cohort of prostate cancer patients in Spain: a multicentre observational study

Zeitschrift:
BMC Urology > Ausgabe 1/2015
Autoren:
Xavier Bonfill, María José Martinez-Zapata, Robin WM Vernooij, María José Sánchez, María Morales Suárez-Varela, Javier de la Cruz, José Ignacio Emparanza, Montserrat Ferrer, José Ignacio Pijoán, Juan M. Ramos-Goñi, Joan Palou, Stefanie Schmidt, Víctor Abraira, Javier Zamora, on behalf of the EMPARO-CU study group
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interest.

Authors’ contributions

Study concepts: XB. Study design: XB, MJM. Data acquisition: All authors. Quality control of data and algorithms: MJM, RV. Data analysis and interpretation: XB, MJM, RV. Statistical analysis: RV, VA. Manuscript preparation: XB MJM, RV. Manuscript editing: All authors. Manuscript review: All authors. All authors read and approved the final manuscript.

Abstract

Background

Little is known about the healthcare process for patients with prostate cancer, mainly because hospital-based data are not routinely published. The main objective of this study was to determine the clinical characteristics of prostate cancer patients, the, diagnostic process and the factors that might influence intervals from consultation to diagnosis and from diagnosis to treatment.

Methods

We conducted a multicentre, cohort study in seven hospitals in Spain. Patients’ characteristics and diagnostic and therapeutic variables were obtained from hospital records and patients’ structured interviews from October 2010 to September 2011. We used a multilevel logistic regression model to examine the association between patient care intervals and various variables influencing these intervals (age, BMI, educational level, ECOG, first specialist consultation, tumour stage, PSA, Gleason score, and presence of symptoms) and calculated the odds ratio (OR) and the interquartile range (IQR). To estimate the random inter-hospital variability, we used the median odds ratio (MOR).

Results

470 patients with prostate cancer were included. Mean age was 67.8 (SD: 7.6) years and 75.4 % were physically active. Tumour size was classified as T1 in 41.0 % and as T2 in 40 % of patients, their median Gleason score was 6.0 (IQR:1.0), and 36.1 % had low risk cancer according to the D’Amico classification. The median interval between first consultation and diagnosis was 89 days (IQR:123.5) with no statistically significant variability between centres. Presence of symptoms was associated with a significantly longer interval between first consultation and diagnosis than no symptoms (OR:1.93, 95%CI 1.29–2.89). The median time between diagnosis and first treatment (therapeutic interval) was 75.0 days (IQR:78.0) and significant variability between centres was found (MOR:2.16, 95%CI 1.45–4.87). This interval was shorter in patients with a high PSA value (p = 0.012) and a high Gleason score (p = 0.026).

Conclusions

Most incident prostate cancer patients in Spain are diagnosed at an early stage of an adenocarcinoma. The period to complete the diagnostic process is approximately three months whereas the therapeutic intervals vary among centres and are shorter for patients with a worse prognosis. The presence of prostatic symptoms, PSA level, and Gleason score influence all the clinical intervals differently.
Literatur
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