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Implications of a new element in the early diagnostic pathway for prostate cancer for rural Australians
Author(s) -
Macneil James,
Wilkins Rachel,
Whelan Clair
Publication year - 2021
Publication title -
australian journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.48
H-Index - 49
eISSN - 1440-1584
pISSN - 1038-5282
DOI - 10.1111/ajr.12763
Subject(s) - prostate cancer , positron emission tomography , medicine , prostate , context (archaeology) , cancer , nuclear medicine , medical physics , paleontology , biology
Aims To demonstrate the magnitude of the potential problem caused by the trend towards using positron emission tomography prostate‐specific membrane antigen scans on men in rural Australia. Context Prostate‐specific membrane antigen positron emission tomography scans have higher sensitivity to detect metastatic prostate cancer than other imaging modalities, especially at lower prostate specific antigen (PSAs). This has led to proposals that prostate‐specific membrane antigen be the gold standard to investigate men with a suspicion of prostate cancer. There is a trial underway in Australia examining the use of positron emission tomography prostate‐specific membrane antigen in pre‐biopsy men. Disparities in access to care and outcomes for prostate cancer for men in rural Australia are well documented. Incorporating positron emission tomography prostate‐specific membrane antigen into the primary diagnostic pathway for prostate cancer creates a risk of further entrenching or worsening this inequity due to the lack of positron emission tomography scanners in rural locations. Approach As a surrogate marker for restricted access, we determined the proportion of men over 50 more than 1.5 hours from a positron emission tomography scanner, with local government areas as the unit of assessment. Conclusion Of the 505 local government areas, 309 were greater than 1.5 hours from the nearest positron emission tomography scanner. Of 3 793 865 men, over 50 585 689 lived in the 309 local government areas with restricted access to a positron emission tomography scanner. Our study highlights the risk of exacerbating inequalities in prostate cancer care experienced by men in rural areas. If positron emission tomography prostate‐specific membrane antigen becomes the new gold standard, one in 6 men will face geographic barriers to access the standard of care. Future considerations of positron emission tomography prostate‐specific membrane antigen must take this into account.