Comparing the clinical profile, management and prognosis of prostate cancer in

indigenous population to non-indigenous population of the Northern territory: Interim

results of ongoing prospective study

Introduction & Objectives:

Prostate cancer is the second most commonly diagnosed cancer only after lung cancer in
Aboriginal and Torres Strait Islander men. Indigenous men as per studies have a lower chance of
surviving five years following a diagnosis of prostate cancer than the general community (63%
compared with 72%). Aboriginal people living in the NT, representing approximately 30.8% of the
Northern territory population. Thus we aim to discuss the demographic profile, clinical
presentation, stage at diagnosis and eventual management and prognosis of these men across
both urban and rural parts of northern territory.
Methods:
The study is a prospective ongoing observational study. However, data is retrieved from October
2017 till June 2023. All the males who identified themselves as either Aboriginal or Torres
islanders in the public healthcare of the Northern territory who were diagnosed to have prostate
cancer following their biopsy were included in the study. Patient who didn’t follow up post biopsy
for at least 1 year were excluded from the study. Once a diagnosis was made, the stage of the
malignancy was determined using PSMA PET CT scan in all patients. Treatment was determined
in consultation with the patients and follow up was as per standard guidelines. There were no
patient reported outcome reports. The data was retrieved from the northern territory database
after seeking consent of each of the patient included in the study. The data was then
dichotomized into two groups – the indigenous and non-indigenous group as per the patients’
records. The results obtained till June 2022 were assessed. All the data was the analyzed using
SPSS 23 software.
Results:
Among the men diagnosed with carcinoma of prostate, 14.6% belonged to Aboriginal or Torres
islander population. Their average age at presentation was 61.25 years as compared to 71.52 for
the rest of the population of Northern Territory. The most common presentation was routine PSA
checkup. The most common ISUP grade was 2 for prostate carcinoma among both the groups.
The most common documented PIRADS score among the 2 groups was PIRADS 4. The stage at
presentation has been compared amongst the 2 groups has been tabulated in Table 1. The
management opted for localized Carcinoma prostate was radiation among the indigenous group
compared to active surveillance in the non-indigenous group. Only one patients who underwent
active surveillance in the indigenous population needed active treatment at the 2 years. Among
the patients who needed active treatment in the indigenous population, those diagnosed with
sexual dysfunction were 36.5%, those noted to have incontinence (more than 3 pads per day
after 3 months of procedure) were 8% and those with bowel dysfunction were 4%. The number of
patients who didn’t follow up post diagnosis for at least one year in the indigenous group were
(23%) versus (8.8%) for the rest of the population.

Table1. Stage at presentation between the indigenous and the non-indigenous population
Stage of presentation Indigenous group Non -indigenous
Localized Low risk 7 (13.7%) 63 (17.9%)
Carcinoma prostate
Localized intermediate 17 (33.3) 126 (35.8%)
risk Carcinoma prostate
Localized High risk 11 (21.5%) 78 (22.2%)
Carcinoma prostate
Locally advanced 7 (13.7%) 31 (8.8%)
Carcinoma prostate
Metastatic Carcinoma 9 (17.6%) 53 (15%)
prostate
Conclusions:

The average age at presentation for indigenous group was significantly lower as compared to the
non-indigenous group. Although the percentage of patients presenting across various stage of
prostate cancer were similar among the two groups, radiation was most common modality of
treatment among the indigenous group where as non-indigenous cohort preferred active
surveillance. This could be due to the age difference in the two groups as well as the
geographical location of the indigenous population may have made active surveillance not an
optimal option. The other significant highlight of this study included post diagnosis follow up which
was significantly less in the Aboriginal and Torres islander group. The long term cancer specific
and overall 5 year survival is still awaited which could be a drawback of this study. This interim
study provides an impetus for a larger prospective nationwide study to compare the outcomes of
prostate cancer especially in the indigenous group utilizing the PCOR registry.