The association of diagnosis in the private or NHS sector on prostate cancer stage and treatment

Background To examine associations of private healthcare with stage and management of prostate cancer. Methods Regional population-based cancer registry information on 15 916 prostate cancer patients. Results Compared with patients diagnosed in the National Health Service (NHS) (94), those diagnosed in private hospitals (5) were significantly more affluent (69 versus 52 in deprivation quintiles 12), younger (mean 69 versus 73 years) and diagnosed at earlier stage (72 versus 79 in Stages <III) (P < 0.001 for all). Private hospital of diagnosis was independently associated with lower probability of advanced disease stage [odds ratio (OR) 0.75, P 0.002], higher probability of surgery use (OR 1.28, P 0.037) and lower probability of radiotherapy use (OR 0.75, P 0.001). Private hospital of diagnosis independently predicted higher surgery and lower radiotherapy use, particularly in more deprived patients aged ≤70. Conclusions In prostate cancer patients, private hospital diagnosis predicts earlier disease stage, higher use of surgery and lower use of radiotherapy, independently of case-mix differences between the two sectors. Substantial socioeconomic differences in stage and treatment patterns remain across centres in the NHS, even after adjusting for private sector diagnosis. Cancer registration data could be used to identify private care use on a population basis and the potential associated treatment disparities.