Challenges and Health Disparities in Prostate Cancer: Healthcare Access as a Driver of Inequities in a Rural Hospital Network

Background: Prostate cancer is the most common male cancer, and second most common cause of cancer mortality in the US. Disparities abound in this disease for reasons that need further study, including social and ethnic barriers, geographic barriers, and biological differences. North Carolina is the second largest state by rural population measures (3.5 million), which provides ample geography to study these disparities. Materials and Methods: A dataset containing all patients with a medical record documenting a diagnosis of and/or treatment for de novo prostate cancer within the mostly rural ECU Health 9-hospital system was characterized over a 20-year period for structural inequities, access barriers, and biological differences. Results: Stages and outcomes of prostate cancer changed temporally, reflecting changes in screening, treatment, and inclusion of prognostic factors such as prostate-specific antigen, Gleason score, and other factors. Late stage (4) prostate cancer disproportionately affected our system as a whole and smaller community hospitals, with higher death rates seen in community, mostly rural programs that lack access to all required components of care. Conclusion: Stages of prostate cancer changed considerably over the study period, reflecting changes in screening recommendations, and staging criteria. Late stage (4) disease increased over the analytic period, was higher than NCDB references by period, and disproportionately affected community programs where resources were sparse, correlating with worse outcomes.