Analysis of early diagnostic pathway for prostate cancer in Slovenia

FIGURE 1.

Sociodemographic and clinical characteristics of prostate cancer patients (N = 814)

Characteristics	Sample of prostate cancer patients, n (%)
Age (mean ± SD), range: 44–97	69.0 ± 8.5
Age, groups
< 65	265 (32.5)
65–75	357 (43.9)
> 75	192 (23.6)
Cancer stage
Localized	572 (70.3)
Spread	191 (23.4)
Metastatic	51 (6.3)
Education
Primary/Elementary education	280 (34.4)
Secondary/High school education	386 (47.4)
Higher education	148 (18.2)
Comorbidities
No. of comorbidities (mean ± SD), range: 0–6	1.2 ± 1.2
None	290 (35.6)
1–2	410 (50.4)
> 2	114 (14)
Number of patients by region of the primary health care centre's location
Pomurska	106 (13)
Podravska	114 (14)
Koroška	31 (3.8)
Savinjska	85 (10.4)
Zasavska	3 (0.4)
Spodnjeposavska	25 (3.1)
JV Slovenija	53 (6.5)
Osrednjeslovenska	204 (25.1)
Gorenjska	69 (8.5)
Notranjsko-kraška	27 (3.3)
Goriška	56 (6.9)
Obalno-kraška	41 (5.0)
Symptoms and signs at first presentation (multiple options possible)
Dysuria	111 (13.6)
LUTS	307 (37.7)
Pain in the abdomen	63 (7.7)
Family history of cancer	17 (2.1)
Elevated PSA	246 (30.2)
Other	130 (16)
Alive 5-years after diagnosis	610 (74.9)

Duration of doctor and primary care interval

	mean (± SD)	range
Doctor interval, days	37.5 (92.8)	0–365
Primary care interval, days	67.4 (123.8)	0–365

5-year survival in relation to sociodemographic and organizational variables

Variables	Dead n (%)	Alive n (%)	P value
Age groups			< 0.001
< 65	32 (12)	233 (88)
65–75	72 (20.2)	285 (79.8)
>75	100 (52)	92 (48)
Education			< 0.001
Primary/Elementary education	91 (32.5)	189 (67.5)
Secondary/High school education	84 (21.8)	302 (78.2)
Higher education	29 (19.6)	119 (80.4)
Region of the location of primary health care centre			NS
Pomurska	32 (30.2)	74 (69.8)
Podravska	34 (29.8)	80 (70.2)
Koroška	9 (29)	22 (71)
Savinjska	18 (21.2)	67 (78.8)
Spodnjeposavska	5 (20)	20 (80)
JV Slovenija	15 (28.3)	38 (71.7)
Osrednjeslovenska	44 (21.6)	160 (78.4)
Gorenjska	17 (24.6)	52 (75.4)
Notranjo-kraška	6 (22.2)	21 (77.8)
Goriška	14 (25)	42 (75)
Obalno-kraška	10 (24.4)	31 (75.6)
Cancer stage			< 0.001
Localized	124 (21.7)	448 (78.3)
Spread	36 (18.8)	155 (81.2)
Metastatic	44 (86.3)	7 (13.7)
Comorbidities			< 0.001
None	72 (24.8)	218 (75.2)
1–2	86 (21)	324 (79)
>2	46 (40.4)	68 (59.6)
GP access to laboratory (CBC, CRP, urine)			< 0.001
Yes	159 (21.7)	575 (78.3)
No	45 (56.2)	35 (43.8)
GP access to laboratory (PSA)			< 0.001
Yes	136 (20.8)	517 (79.2)
No	68 (42.2)	93 (57.8)
GP access to US			< 0.05
Yes	62 (20.3)	244 (79.7)
No	142 (28)	366 (72)
Symptomatic patient			< 0.001
Yes	103 (25.8)	296 (74.2)
No	29 (13.2)	190 (86.8)

Diagnostic procedures performed by the general practitioner (GP) and their access to laboratory and abdominal ultrasound within the primary health care centre, overall and by region (N = 811)

Diagnostic procedures performed by GPs	Sample of prostate cancer patients, n (%)
CBC, CRP			497 (61.1)
PSA			664 (81.6)
Urine			471 (57.9)
US			434 (53.3)
DRE			255 (31.3)
Diagnostic procedures performed by GPs by region	CBC, CRP	PSA	urine	US	DRE
Pomurska (N = 106)	48 (45.3)	77 (72.6)	52 (49.1)	39 (36.8)	34 (32.1)
Podravska (N = 114)	77 (67.5)	95 (83.3)	60 (52.6)	68 (59.6)	23 (20.2)
Koroška (N = 31)	15 (48.4)	24 (77.4)	13 (41.9)	4 (12.9)	11 (35.5)
Savinjska (N = 85)	55 (64.7)	64 (75.3)	61 (71.8)	50 (58.8)	26 (30.6)
Spodnjeposavska (N = 25)	14 (56)	20 (80)	16 (64)	11 (44)	13 (52)
JV Slovenija (N = 53)	35 (66)	39 (73.6)	25 (47.2)	19 (35.8)	11 (20.8)
Osrednjeslovenska (N = 204)	135 (66.2)	180 (88.2)	131 (64.2)	140 (68.6)	46 (22.5)
Gorenjska (N = 69)	48 (69.6)	63 (91.3)	44 (63.8)	39 (56.5)	22 (31.9)
Notranjsko-kraška (N = 27)	21 (77.8)	23 (85.2)	19 (70.4)	20 (74.1)	15 (55.6)
Goriška (N = 56)	28 (50)	45 (80.4)	29 (51.8)	22 (39.3)	33 (58.9)
Obalno-kraška (N = 41)	19 (46.3)	32 (78)	19 (46.3)	20 (48.8)	19 (46.3)
Accessibility to diagnostic tests in the primary health care centre	Sample of prostate cancer patients, n (%)
Laboratory (CBC, CRP, urine)	734 (90.2)
Laboratory (PSA)	653 (80.2)
US	306 (37.6)
Accessibility to diagnostic tests in the primary health care centre by region	CBC, CRP, urine		PSA	US
Pomurska (N = 106)	96 (90.6)		79 (74.5)	34 (32.1)
Podravska (N = 114)	98 (86)		89 (78.1)	42 (36.8)
Koroška (N = 31)	28 (90.3)		26 (83.9)	22 (71)
Savinjska (N = 85)	78 (91.8)		63 (74.1)	36 (42.4)
Spodnjeposavska (N = 25)	23 (92)		16 (64)	10 (40)
JV Slovenija (N = 53)	46 (86.8)		42 (79.2)	15 (28.3)
Osrednjeslovenska (N = 204)	187 (91.7)		173 (84.8)	74 (36.3)
Gorenjska (N = 69)	63 (91.3)		60 (87)	31 (44.9)
Notranjsko-kraška (N = 27)	24 (88.9)		20 (74.1)	7 (25.9)
Goriška (N = 56)	53 (94.6)		52 (92.9)	23 (41.1)
Obalno-kraška (N = 41)	36 (87.8)		31 (75.6)	12 (29.3)

The distribution and association of selected characteristics with doctor and primary care interval_ (N = 811)

	N	%	Doctor Interval			Primary care interval
			Median	Interquartile range	P	Median	Interquartile range	P
Age groups					0.131			0.382
< 65	264	32.55	0	0–4		5	0–65
65–75	355	43.77	0	0–5		4	0–51
> 75	192	23.67	0	0–20		7	0–73
Education					0.437			0.204
Primary/Elementary education	278	34.28	0	0–6		7	0–38
Secondary/High school education	385	47.47	0	0–5		3	0–53
Higher education	148	18.25	0	0–18		7	0–127
Region of the location of primary health care centre					0.863			0.021
Pomurska	106	13.07	0	0–18		3	0–62
Podravska	114	14.06	0	0–20		8	0–50
Koroška	31	3.82	0	0–20		0	0–42
Savinjska	85	10.48	0	0–3		0	0–28
Spodnjeposavska	25	3.08	0	0–10		3	0–91
JV Slovenija	53	6.54	0	0–7		1	0–62
Osrednjeslovenska	204	25.15	0	0–5		10	0–88
Gorenjska	69	8.51	0	0–2		4	0–54
Notranjo-kraška	27	3.33	0	0–7		6	0–127
Goriška	56	6.90	0	0–5		4	0–34
Obalno–kraška	41	5.06	0	0–20		4	0–48
Cancer stage					0.037			0.058
Localized	569	70.16	0	0–8		6	0–65
Spread	191	23.55	0	0–1		1	0–28
Metastatic	51	6.29	0	0–38		3	0–336
Comorbidities					0.001			0.026
None	288	35.51	0	0–31		7	0–101
1–2	409	50.43	0	0–4		5	5–44
> 2	114	14.06	0	0–1		0	0–33
GP access to laboratory (CBC, CRP, urine)					< 0.001			< 0.001
Yes	732	90.26	0	0–4		3	0–37
No	79	9.74	40	0–330		365	0–365
GP access to laboratory (PSA)					< 0.001			< 0.001
Yes	651	80.27	0	0–2		3	0–37
No	160	19.73	0	0–177		21	0–365
GP access to US					0.781			0.124
Yes	306	37.73	0	0–5		4	0–31
No	505	62.27	0	0–7		5	0–78
Symptomatic patient					< 0.001			0.001
Yes	399	49.20	0	0–12		5	0–42
No	219	27.00	0	0–0		0	0–18

Logistic regression model on predicting primary care interval

Variables in the Equation	B	Wald	Exp(B) (95% CI)
Age	−0.004	0.144	0.996 (0.979, 1.015)
Education primary vs secondary	−0.359	4.223	0.698 (0.496, 0.984)*
Education primary vs higher	0.145	0.452	1.156 (0.757, 1.765)
Cancer stage localized vs spread	−0.336	3.315	0.714 (0.497, 1.026)
Cancer stage localized vs metastatic	−0.316	0.955	0.729 (0.387, 1.374)
No comorbidities	−0.070	1.051	0.932 (0.815, 1.066)
First symptom - dysuria	−0.175	0.592	0.840 (0.538, 1.310)
First symptom – LUTS	−0.084	0.228	0.919 (0.650, 1.300)
First symptom – abdominal pain	0.132	0.222	1.141 (0.659, 1.977)
First symptom – family history of cancer	0.257	0.249	1.293 (0.471, 0.913)
First symptom – elevated PSA	−0.486	5.804	0.615 (0.414, 0.913)*
Accessible US diagnostics	−0.160	0.940	0.852 (0.616, 1.178)
Accessible laboratory diagnostics (PSA)	−0.196	0.660	0.822 (0.512, 1.319)
Accessible laboratory diagnostics (CBC, CRP, urine)	−1.139	11.375	0.320 (0.165, 0.620)***
Constant	1.483	4.119	4.405*