Older men with prostate cancer do not receive the same treatment in Norway.

It presents a national study on differences in the treatment of older patients (70 years or older) with high-risk prostate cancer. The study was conducted by the Centre for Clinical Documentation and Evaluation (SKDE) and UiT The Arctic University of Norway.

Different Treatments

Prostate cancer is the most common form of cancer in Norway, with over 5,000 men diagnosed each year. Primarily, it affects older men.

High-risk prostate cancer is an aggressive type of cancer. Norwegian guidelines therefore recommend treatment for patients with this diagnosis, as long as the patient is not too old or in poor health.

— The study shows that the likelihood of receiving treatment varies based on the patient's background. Income, education, and where they live in the country matter, says Elin M. Gustavsen, postdoctoral researcher at SKDE and the first author of the article.

In Norway, everyone is entitled to equal healthcare services, regardless of background, where they live, or how old they are. This is fundamental to Norwegian health policy.

— Nevertheless, older men with high income and education are more likely to receive treatment for high-risk prostate cancer than those with low income and education, Gustavsen points out.

For some patients, the treatment can be tough to undergo. Patients with a good understanding of their health situation may appear more inclined to follow a demanding treatment regimen when interacting with doctors and the healthcare system. Other research shows that patients with higher education and income often have greater health knowledge and are better able to utilise this knowledge for their own benefit.

Different Treatment Practices

The likelihood of receiving treatment for high-risk prostate cancer also varies by location. The proportion of older patients receiving treatment is highest in Western Norway and lowest in Southern Norway. The variation cannot be explained by differences in patients' age, morbidity, or income and education levels.

Older men with prostate cancer are not a homogeneous group in terms of health. Particularly among those in poor health, it can be difficult for doctors to assess whether treatment will be beneficial. Hospitals may have different practices (in patient assessment) that lead to geographical differences in access to treatment.

Photo: Ørjan Marakatt Bertelsen

The Important Shared Decision-Making

The study also shows that the type of treatment patients receive varies by location. In Telemark, the majority of patients are treated surgically, while almost all patients residing in Western Norway receive radiotherapy.

Surgery and radiotherapy are equivalent treatments for high-risk prostate cancer but can lead to different side effects after treatment. Decisions regarding treatment, and possibly which type of treatment, should therefore be a choice made jointly by the patient and the doctor.

Elin M. Gustavsen does not believe that the geographical differences in treatment choices reflect disparities in patients' preferences across the country.

— The differences are likely due to varying practices and what clinicians prefer. In Norway, equitable healthcare services for the population are a high priority in health policy. The regional health enterprises have a responsibility to ensure that everyone, regardless of background and where they live, receives an equitable healthcare offer. Nevertheless, the study shows that this does not apply to older patients with high-risk prostate cancer. This should not be the case. Every patient, regardless of background, has the right to good and tailored treatment, she says.

The study is part of Gustavsen's PhD thesis. She defended it on 25 April this year.

You can read the full study here.

Illustration: SKDE