# Prostate Cancer Disparities Between Public and Private Healthcare Patients in Tasmania, a Regional State of Australia

## TL;DR

Prostate cancer patients in Tasmania's public healthcare system face disparities in treatment access and outcomes compared to those in private healthcare.

## Contribution

This study reveals significant differences in prostate cancer care between public and private healthcare systems in Tasmania, highlighting treatment access disparities.

## Key findings

- Public healthcare patients were more likely to have higher-risk prostate cancer and receive active treatment.
- Private healthcare patients were more likely to be managed with active surveillance for low-risk disease.
- Public patients experienced longer delays in starting treatment compared to private patients.

## Abstract

Tasmania is a fully regional state of Australia, with the highest rate of prostate cancer-specific mortality in the country. Tasmanian prostate cancer patients may be treated in public or private healthcare institutions. A range of treatments are available, each associated with advantages and disadvantages. We found significant differences between Tasmanian prostate cancer patients treated in the public and private healthcare systems in terms of diagnostic characteristics, likelihood of undergoing active treatment, treatment type, and time to commence treatment. Our findings have diverse implications for both clinicians and patients, showing that further investigation into treatment access and equity is needed.

Background: Prostate cancer (PrCa) outcomes are inferior in regional and rural areas compared to metropolitan centres. We evaluated patterns of care in PrCa patients treated in public and private healthcare facilities in regional Tasmania. Methods: This retrospective study used clinicopathological data for 2180 PrCa patients diagnosed between 2015–2022. Descriptive statistics and regression analyses determined associations between treatment facility (public vs. private) and diagnostic and treatment factors. Results: A significantly greater proportion of public patients were from outer regional/remote areas (prevalence ratio (PR) = 1.25, 95% CI: 1.19–1.31), presented with higher-risk disease (PR = 1.56, 95% CI: 1.22–2.00) and underwent active treatment compared to private patients (PR = 1.07, 95% CI: 1.03–1.11). Men treated privately were most likely to have low-risk PrCa (p < 0.001) and be managed with active surveillance (AS, 52.9%). When stratified by disease risk, public patients with intermediate (p < 0.001) or very high-risk/metastatic disease (p = 0.003) were still significantly more likely to receive active treatment than private patients. Furthermore, except for very high-risk/metastatic patients, public patients took significantly longer to commence treatment, ranging between a mean difference of 40 to 59 days depending on risk category. Conclusions: In Tasmania, treatment pathways for PrCa patients differ significantly between public and private healthcare sectors and may contribute to poorer outcomes in regional and remote areas.