title: Clinical intervals and diagnostic characteristics in a cohort of prostate cancer patients in Spain: a multicentre observational study.
abstract: BACKGROUND
  Little is known about the healthcare process for patients with prostate cancer, mainly because hospital-based data are not routinely published. The main objective of this study was to determine the clinical characteristics of prostate cancer patients, the, diagnostic process and the factors that might influence intervals from consultation to diagnosis and from diagnosis to treatment.
  
  
  METHODS
  We conducted a multicentre, cohort study in seven hospitals in Spain. Patients' characteristics and diagnostic and therapeutic variables were obtained from hospital records and patients' structured interviews from October 2010 to September 2011. We used a multilevel logistic regression model to examine the association between patient care intervals and various variables influencing these intervals (age, BMI, educational level, ECOG, first specialist consultation, tumour stage, PSA, Gleason score, and presence of symptoms) and calculated the odds ratio (OR) and the interquartile range (IQR). To estimate the random inter-hospital variability, we used the median odds ratio (MOR).
  
  
  RESULTS
  470 patients with prostate cancer were included. Mean age was 67.8 (SD: 7.6) years and 75.4% were physically active. Tumour size was classified as T1 in 41.0% and as T2 in 40% of patients, their median Gleason score was 6.0 (IQR:1.0), and 36.1% had low risk cancer according to the D'Amico classification. The median interval between first consultation and diagnosis was 89 days (IQR:123.5) with no statistically significant variability between centres. Presence of symptoms was associated with a significantly longer interval between first consultation and diagnosis than no symptoms (OR:1.93, 95%CI 1.29-2.89). The median time between diagnosis and first treatment (therapeutic interval) was 75.0 days (IQR:78.0) and significant variability between centres was found (MOR:2.16, 95%CI 1.45-4.87). This interval was shorter in patients with a high PSA value (p = 0.012) and a high Gleason score (p = 0.026).
  
  
  CONCLUSIONS
  Most incident prostate cancer patients in Spain are diagnosed at an early stage of an adenocarcinoma. The period to complete the diagnostic process is approximately three months whereas the therapeutic intervals vary among centres and are shorter for patients with a worse prognosis. The presence of prostatic symptoms, PSA level, and Gleason score influence all the clinical intervals differently.
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Xbonfill@santpau.cat.|Institute of Biomedical Research (IIB Sant Pau), Iberoamerican Cochrane Centre, Barcelona, Spain. Xbonfill@santpau.cat.|Universitat Autònoma de Barcelona, Barcelona, Spain. Xbonfill@santpau.cat.|Public Health and Clinical Epidemiology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Xbonfill@santpau.cat.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bonfill
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. mmartinezz@santpau.cat.|Institute of Biomedical Research (IIB Sant Pau), Iberoamerican Cochrane Centre, Barcelona, Spain. mmartinezz@santpau.cat.|Universitat Autònoma de Barcelona, Barcelona, Spain. mmartinezz@santpau.cat.
authors.forename: María José
authors.initials: MJ
authors.lastname: Martinez-Zapata
authors.affiliation: Institute of Biomedical Research (IIB Sant Pau), Iberoamerican Cochrane Centre, Barcelona, Spain. rwmvernooij@cochrane.es.
authors.forename: Robin W M
authors.initials: RW
authors.lastname: Vernooij
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. mariajose.sanchez.easp@juntadeandalucia.es.|Instituto de Investigación Biosanitaria de Granada, Escuela Andaluza de Salud Pública, Granada, Spain. mariajose.sanchez.easp@juntadeandalucia.es.
authors.forename: María José
authors.initials: MJ
authors.lastname: Sánchez
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Maria.M.Morales@uv.es.|Department of Preventive Medicine, Unit of Public Health and Environmental Care, University of Valencia, Center for Public Health Research (CSISP), Valencia, Spain. Maria.M.Morales@uv.es.
authors.forename: María Morales
authors.initials: MM
authors.lastname: Suárez-Varela
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. jdlcruz@h12o.es.|Hospital 12 de Octubre, Madrid, Spain. jdlcruz@h12o.es.
authors.forename: Javier
authors.initials: J
authors.lastname: de la Cruz
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. JOSEIGNACIO.EMPARANZA@osakidetza.net.|Clinical Epidemiology Unit, Hospital Universitario Donostia, BioDonostia, San Sebastian, Spain. JOSEIGNACIO.EMPARANZA@osakidetza.net.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Emparanza
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. mferrer@imim.es.|IMIM (Hospital del Mar Medical Research Institute), Health Services Research Group, Barcelona, Spain. mferrer@imim.es.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. joseignacio.pijoanzubizarreta@osakidetza.net.|Unidad de Epidemiología Clínica y Soporte Metodológico, UICEC de BioCruces-SCReN, Barakaldo, Spain. joseignacio.pijoanzubizarreta@osakidetza.net.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Pijoán
authors.affiliation: Health Services Research on Chronic Patients Network (REDISSEC), HTA Unit of the Canary Islands Health Service (SESCS), S/C de Tenerife, La Laguna, Spain. juanmanuel.ramosgoni@gmail.com.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Ramos-Goñi
authors.affiliation: Universitat Autònoma de Barcelona, Barcelona, Spain. jpalou@fundacio-puigvert.es.|Fundació Puigvert, Barcelona, Spain. jpalou@fundacio-puigvert.es.
authors.forename: Joan
authors.initials: J
authors.lastname: Palou
authors.affiliation: Department of Experimental and Health Sciences, Universidad Pompeu Fabra (UPF), Barcelona, Spain. sschmidt@imim.es.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schmidt
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. victor.abraira@gmail.com.|Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain. victor.abraira@gmail.com.
authors.forename: Víctor
authors.initials: V
authors.lastname: Abraira
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. javier.zamora@hrc.es.|Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain. javier.zamora@hrc.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Zamora
mesh_terms: D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D019091:Critical Pathways / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D013030:Spain / Q000453:epidemiology; D061665:Time-to-Treatment / Q000706:statistics & numerical data*