PROSTATE cancer (PC) is a leading cause of cancer-related death among men, with over 1.4 million new cases and 375,000 deaths annually worldwide. Advances in early detection and treatment have improved outcomes, but significant disparities in PC presentation persist across populations. In Ireland, socio-economic status (SES) and geographic location play crucial roles in these inequities, shaping the entire disease continuum, from screening and diagnosis to treatment and outcomes.
Opportunistic prostate-specific antigen (PSA) screening is commonly used in Ireland, as there is no universal screening programme. However, PSA testing often occurs without shared decision-making or thorough risk assessment, contributing to overdiagnosis, medical harm, and inequities. Ireland’s two-tier healthcare system, characterised by both public and private providers, amplifies these disparities. Public patients often face long wait times and financial barriers, while private insurance holders receive expedited care.
The introduction of rapid access prostate clinics (RAPCs) aimed to streamline referrals and improve diagnosis. While these clinics have increased PC detection rates, challenges persist. Urban residents, despite better access to healthcare facilities, are diagnosed with more advanced PC compared to rural patients. This may reflect overloaded urban healthcare systems causing delays in diagnosis and treatment. Additionally, middle SES groups experience lower rates of opportunistic screening, likely due to financial barriers and ineligibility for free medical care.
Addressing these disparities requires targeted interventions. Implementing risk-based screening programmes that account for SES and geographic differences could enhance early detection. Public awareness campaigns should prioritise rural and socio-economically disadvantaged areas, promoting the importance of PC screening. Reducing the financial burden of screening for middle and lower SES groups is essential, alongside policies to improve healthcare accessibility.
Although this study offers valuable insights, limitations include its observational design and lack of data on racial disparities. Future research should explore access to treatments and outcomes to fully understand Ireland’s PC disparities. By addressing these gaps, Ireland can move towards a more equitable approach to prostate cancer care.
Katie Wright, EMJ
Reference
Gordon N et al. Are we there yet? Closing the gap of prostate cancer presentation disparities in Ireland. Arch Public Health. 2024;82:210.
