Inequalities in baseline patient reported outcomes at prostate cancer diagnosis in an Irish cohort

Background

Pre-treatment assessment of patient-reported outcome measures (PROMs) in prostate cancer (PCa) patients provides context for treatment decisions and changes in urinary, bowel and sexual domains. Since 2025, the Irish Prostate Cancer Outcomes Research (IPCOR) has been collecting PROMs at diagnostic biopsy, facilitating linkage of sociodemographic factors with pre-treatment symptoms and diagnoses.

Methods

Descriptive analyses outline demographic and clinical characteristics. Baseline EPIC-26, EORTC QLQ-C30 and PR25 scores were compared by tumour positivity at biopsy, symptoms and treatment pathways. Unadjusted associations were examined using ANOVA and chi‑square tests. Multivariable linear regression models identified independent predictors of PROM variation.

Results

Baseline PROMs were available for 383 participants (68% tumour positive). Tumour‑positive men were significantly older (mean 65.5 vs 61.3 years; p < 0.001). In unadjusted analyses, income, occupation, education, smoking and ethnicity were associated with variation across multiple PROM domains. No statistically significant differences were reported between PCa and non-cancer groups or across treatment groups. Older age was associated with lower odds of surgical treatment (aOR 0.86, 95% CI 0.75-0.96). Greater comorbidity burden (e.g. EPIC-26 urinary irritative: β -3.6, 95% CI -5.78 to -1.03, p = 0.005) and older age (e.g. EORTC-QLQ-C30 diarrhoea symptoms: β -0.52, 95% CI -0.88 to -0.15, p = 0.006) were the main predictors of poorer baseline PROM scores. Socioeconomic variables demonstrated moderate associations after adjustment.

Conclusions

Baseline inequalities are evident at diagnosis: older age and comorbidity burden independently predict both poorer PROMs and higher tumour positivity. Baseline PROMs should be considered in patient-centred treatment decisions. These findings highlight the need for equity‑focused assessment and tailored support at diagnosis and treatment selection.

Key messages

• Irish PROMs data show that collecting baseline outcomes at diagnosis supports patient‑centred treatment decisions. This equity‑focused approach may inform prostate cancer care pathways across Europe.

• Inequalities in prostate cancer are apparent at diagnosis. Addressing them could improve equitable care in Ireland and may have relevance for broader European contexts.