Men with an intellectual disability face significant inequalities throughout the entire prostate cancer care pathway, according to a large UK population-based cohort study, highlighting the need for targeted interventions to address these disparities.

Researchers analysed anonymised data from the Clinical Practice Research Datalink Aurum database, which was linked to hospital, cancer registry and mortality records across England, with results published in the journal European Urology Oncology.

Some 29,554 men with an intellectual disability, of whom 241 were diagnosed with prostate cancer, were included, as well as 518,739 controls, 8,929 of whom had a prostate cancer diagnosis.

Primary outcomes included prostate cancer-specific mortality and survival, while secondary outcomes covered prostate-specific antigen (PSA) testing, referral, biopsy, diagnosis and treatment patterns.

The median age at study entry was 52 years, and the median follow-up duration was 5.4 years overall. However, those with an intellectual disability were more likely to reside in areas of higher deprivation and had shorter follow-up periods due to increased all-cause mortality.

Inequalities across the prostate cancer care pathway

Men with intellectual disabilities were more likely to experience symptoms suggestive of prostate cancer compared with controls (20.6% vs 13.1%) but were significantly less likely to receive prompt investigation.

PSA testing within 90 days of symptom presentation occurred in 15.8% of men with intellectual disabilities compared with 25.5% of controls (risk ratio [RR] 0.66, 95% CI 0.63–0.70).

Following an elevated PSA result, further disparities were observed. Referral rates within 28 days were lower (18.2% vs 21.6%; RR 0.83, 95% CI 0.72–0.96), as were biopsy rates (5.5% vs 9.3%; RR 0.54, 95% CI 0.41–0.71) and subsequent diagnosis within 56 days (7.7% vs 15.1%; RR 0.51, 95% CI 0.41–0.65).

Men with intellectual disabilities were also nearly six times more likely to have prostate cancer first recorded on the date of death (RR 5.96, 95% CI 2.70–11.77), suggesting delayed or missed diagnosis.

Higher mortality, advanced disease and intellectual disability

Among those diagnosed with prostate cancer, men with an intellectual disability were more likely to present with metastatic disease (15.1% vs 8.8%; RR 1.79, 95% CI 1.15–2.77) and to have missing Gleason scores (32.0% vs 18.0%; RR 1.61, 95% CI 1.27–2.01).

Rates of clinically significant disease were similar between groups, although radical treatment for non-metastatic disease was lower in the disability group (46.7% vs 63.1%; RR 0.73, 95% CI 0.51–1.00).

Prostate cancer-specific mortality was substantially higher among men with intellectual disability: 26.0% died during follow-up compared with 15.0% of controls, corresponding to more than double the risk of death (hazard ratio [HR] 2.11).

Outcomes worsened with increasing severity of intellectual disability, with HRs for prostate cancer mortality rising to 5.10 in those with severe impairment.

Several limitations were identified by the authors, including the relatively low number of men over 70 years of age – the group most frequently diagnosed with prostate cancer.

The study also lacked a detailed clinical context to determine whether lower investigation rates were clinically appropriate and did not assess treatment for advanced disease, they said. Potential inaccuracies in cause-of-death recording may have also influenced mortality estimates.

Implications for prostate cancer care

Commenting on the study findings, lead author Dr Oliver Kennedy, clinical lecturer at the University of Manchester and the Christie NHS Foundation Trust, said: ‘Learning disabilities are increasingly recognised as a hidden driver of cancer mortality. However, evidence on prostate cancer care in this population is limited.

‘This study is the first to identify specific points along the prostate cancer diagnostic and treatment pathway that may contribute to poorer outcomes for patients with a learning disability.’

He added: ‘Addressing these health disparities has been recognised as a priority by the NHS Long Term Plan, National Institute for Health and Care Excellence guidance, and the Learning from Lives and Deaths programme in England.

‘We hope our study provides strong evidence that prostate cancer should be part of that conversation.’

Previous research from Dr Kennedy also showed that individuals with an intellectual disability have higher cancer risk, more diagnoses outside urgent suspected cancer pathways, fewer treatments and poorer prognosis.

Reference
Kennedy OJ et al. Prostate Cancer Care for Men with an Intellectual Disability: A Population-based Cohort Study of Symptoms, Diagnosis, Treatment and Survival. Eur Urol Oncol 2026;doi.org/10.1016/j.euo.2026.01.004.