title: Comparison of the epidemiologic features and patterns of initial care for prostate cancer between public and private institutions: a survey by the Brazilian Society of Urology.
abstract: OBJECTIVE
  To describe the epidemiological features and patterns of initial care for prostate cancer at public and private institutions in the State of Sao Paulo, Brazil.
  
  
  METHODS
  A total of 1,082 physicians affiliated to the Sao Paulo Section of the Brazilian Society of Urology were invited to participate in this cross-sectional, web-based survey. Between September 2004 and September 2005, participating urologists entered data on demographic, clinical and pathological characteristics of patients diagnosed with prostate cancer in their practice. Data on patients attended at public institutions were analyzed and compared with those patients attended at private practice.
  
  
  RESULTS
  One hundred and ten society members contributed with data from 1915 patients, 1026 (53.6%) of whom from public institutions. When compared with patients attended at private institutions, those attended at public institutions were older and more likely to be black, had higher serum prostate specific antigen (PSA) levels, had a higher probability of being diagnosed with metastatic disease, but were less likely to undergo prostatectomy (all P < 0.001). In multivariate analysis, age, biopsy Gleason score, and being attended at a public institution were independently associated with metastatic disease upon diagnosis. The significant predictors of nonsurgical treatment were age, black race, and higher serum levels of PSA.
  
  
  CONCLUSIONS
  A statewide registry provides valuable information regarding patient demographics, clinical features, and patterns of care. The results of this study suggest that significant disparities exist for patients with prostate cancer attended at different health-care systems. The relative contribution of biological versus socioeconomic features remains uncertain.
authors.affiliation: Sociedade Brasileira de Urologia, Section Sao Paulo, Brazil.
authors.forename: Aguinaldo Cesar
authors.initials: AC
authors.lastname: Nardi
authors.forename: Rodolfo Borges dos
authors.initials: RB
authors.lastname: Reis
authors.forename: Stenio de Cassio
authors.initials: Sde C
authors.lastname: Zequi
authors.forename: Archimedes
authors.initials: A
authors.lastname: Nardozza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006269:Health Facilities, Proprietary; D006801:Humans; D008297:Male; D008875:Middle Aged; D011331:Private Practice / Q000706:statistics & numerical data*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000628:therapy*; D017150:Public Sector / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012955:Societies, Medical; D012959:Socioeconomic Factors; D014572:Urology
chemical_list: D017430:Prostate-Specific Antigen