Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Primary Healthcare Centre Grosuplje, Grosuplje, Slovenia.
Radiol Oncol. 2024 Oct 4;58(4):544-555. doi: 10.2478/raon-2024-0046. eCollection 2024 Dec 1.
Prostate cancer (PCa) is a prevalent male malignancy globally. Prolonged diagnostic intervals are associated with poorer outcomes, emphasizing the need to optimize this process. This study aimed to evaluate the doctor and primary care interval, research their impact on patient survival and explore opportunities to improve PCa diagnostic pathway in primary care.
A retrospective cohort study using cancer patients' anonymised primary care data and data of the Slovenian Cancer Registry.
The study found that the doctor interval had a median duration of 0 days (interquartile range ([IQR] 0-6) and primary care interval a median duration of 5 days (IQR 0-58). Longer intervals were observed in patients with more than two comorbidities, where general practitioners didn't have access to laboratory diagnostic tests within their primary health care centre and when patients first presented with symptoms (reported symptoms at first presentation: dysuria, lower urinary tract symptoms [LUTS], abdominal pain). The analysis also revealed a statistically significant association between lower 5-year survival rate and the accessibility of laboratory and ultrasound diagnostics in primary healthcare centres and a shorter 5-year survival of symptomatic patients in comparison to patients who were identified by elevated levels of prostate specific antigen (PSA).
This study shows that treating suspected PCa in primary care has a significant impact on 5-year survival. Several factors contribute to better survival, including easy access to laboratory and abdominal ultrasound in primary care centres. The study highlights the complex array of factors shaping PCa diagnosis, beyond individual clinicians' skills, encompassing test and service availability.
前列腺癌（PCa）是全球普遍存在的男性恶性肿瘤。诊断间隔时间延长与预后较差有关，这强调了优化这一过程的必要性。本研究旨在评估医生和初级保健间隔时间，研究其对患者生存的影响，并探讨改善初级保健中 PCa 诊断途径的机会。
本研究使用癌症患者匿名初级保健数据和斯洛文尼亚癌症登记处的数据进行回顾性队列研究。
研究发现，医生间隔的中位数为 0 天（四分位距（IQR）0-6），初级保健间隔的中位数为 5 天（IQR 0-58）。在合并症多于两种、全科医生无法在其初级保健中心获得实验室诊断测试以及患者首次出现症状（首次就诊时报告的症状：排尿困难、下尿路症状[LUTS]、腹痛）的患者中观察到更长的间隔时间。分析还显示，在初级保健中心实验室和超声诊断的可及性与较低的 5 年生存率之间存在统计学显著关联，与因前列腺特异性抗原（PSA）水平升高而确诊的患者相比，有症状的患者的 5 年生存率较低。
本研究表明，在初级保健中治疗疑似 PCa 对 5 年生存率有重大影响。有几个因素有助于提高生存率，包括在初级保健中心更容易获得实验室和腹部超声检查。该研究强调了影响 PCa 诊断的一系列复杂因素，这些因素超出了个别临床医生的技能范围，包括测试和服务的可用性。
