Rapid Fire Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Ethnic and geographic variations in prostate cancer testing and incidence in New South Wales: A Population-based cohort study (146324)

MD Mijanur Dr Rahman 1 2 , Siphiwe Ms Ratladi 1 2 , Fiona Assoc Profc Prof Stanaway 3 , Vikneswary Dr Batumalai 4 , Maryam Dr Naghsh Nejad 5 , Richard Prof Lourenco 5 , Abhijit Assoc Prof Pal 6 7 8 , Viet Dr Do 6 , Geoff Prof Delaney 1 2 6 , Mei Ling Assoc Prof Yap 1 2 4 6
  1. School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
  2. Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
  3. Sydney School of Public Health, , University of Sydney, Sydney, Australia, Sydney, NSW, Australia
  4. The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
  5. Centre for Health Economics Research and Evaluation , Faculty of Health, University of Technology Sydney , Sydney, NSW, Australia
  6. South Western Sydney LHD, Sydney, NSW, Australia
  7. Western Sydney University, Sydney, NSW, Australia
  8. Ingham Institute of Applied Medical Research, SWSLHD, Sydney, NSW, Australia

Aims: Evidence on prostate cancer testing and incidence by ethnicity remains limited, with most studies relying on country of birth or language spoken at home as proxies. We aimed to examine ethnic and geographic variations in prostate-specific antigen (PSA) testing uptake and prostate cancer incidence.

Methods: We used data from the Australian Bureau of Statistics’ Person Level Integrated Data Asset (PLIDA) and linked NSW Cancer Registry. The study cohort included men aged 18 years and over (n=2,421,688) who participated in the 2016 Census and were followed for incident prostate cancer until 2022. PSA testing was identified from Medical Benefit Schedule until 2025 for men aged 50-69 (n=1,142,995). Ethnicity was derived from the two ancestry responses recorded in the Census. Age-standardised prostate cancer incidence rates (IR) per 100,000 person-years and PSA testing uptake per 1,000 person-years were calculated. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated using Poisson regression.

Results: 33,567 men diagnosed with prostate cancer during the study period. The highest incidence rates were observed among men of Southern and East Africa (IR=354; 95%CI=290-430) followed by Anglo-Celtic (IR=337; 95%CI=332–341), and other European ethnicity, including Western European (IR=339; 95%CI=319–359). Māori (154, 95% CI=144- 164) and Central and West African (160, 95% CI=145- 175) had substantially lower PSA testing uptake than the population average uptake rate (188, 95%CI: 187- 189). Men residing in outer regional and remote areas (IRR= 1.21; 95%CI=1.16-1.26) had significantly higher prostate cancer incidence rate than those in major cities, despite lower PSA testing uptake rate (IRR=0.98, 95%CI=0.97-0.99).

Conclusions:  Higher prostate cancer incidence despite lower PSA testing uptake among some ethnic groups and those living in remote/outer regions suggests potential inequities to testing, diagnostic pathways, or both. Future work will examine the flow-on effects of these disparities on prostate cancer stage and survival.