Aim: The aim of the study is to provide an overview of the current state of early management of prostate cancer patients in primary care clinics in Slovenia and to assess whether, and where, professionally unacceptable delays or deviations occur in their care process.
Hypotheses: The primary care interval significantly varies between different regions in Slovenia and is associated with disease presentation, patient characteristics, and the organization of healthcare services. A longer primary care interval is linked to shorter five-year survival.
Methods: In this retrospective cohort study, we included 1,431 patients from the Slovenian Cancer Registry database who were diagnosed with prostate cancer in 2014. Their general practitioners collected data from medical records regarding the initial symptoms of the disease, diagnostic procedures performed, referrals, and direct access to diagnostic services (laboratory tests, abdominal ultrasound) at their healthcare centers. The date of first presentation was defined as the first contact with a physician for signs or symptoms related to prostate cancer. The duration of the primary care interval was calculated based on the date of first presentation and the date the referral to a urologist was issued.
Results: The median duration of the primary care interval was 5 days (IQR: 0–58 days), with an average of 67.4 days (SD: 123.8), influenced by extreme values. Longer intervals were associated with the presence of symptoms at first presentation, multiple comorbidities, higher education levels, and particularly with the lack of direct access to laboratory tests (hemogram, CRP, PSA) and abdominal ultrasound in outpatient clinics. A longer primary care interval was statistically significantly associated with shorter five-year survival, with an average interval of 90.18 days among deceased patients compared to 59.79 days among survivors (p = 0.007). Older age at diagnosis, the presence of metastases, and comorbidities were associated with an increased risk of mortality, while direct access to laboratory tests was linked to a reduced risk. There were no differences observed between different regions in Slovenia.
Conclusions: The study highlights the complex range of factors influencing the management of suspected prostate cancer, including not only the competencies of individual physicians but also the availability of tests and services. Longer intervals are associated with poorer five-year survival. Shorter primary care intervals are primarily facilitated by direct access to laboratory diagnostics and ultrasound of the abdomen in primary healthcare centers.
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