Men With Learning Disabilities Experience Worse Prostate Cancer Outcomes

Substantial inequalities in prostate cancer outcomes have been found among patients with intellectual disabilities vs those without intellectual disabilities, according to findings from a population-based study published in European Urology Oncology.¹

Among 29,554 men with intellectual disabilities vs 518,739 men without, a greater proportion of the former experienced at least 1 symptom indicative of prostate cancer (20.6%) vs the latter (13.1%). Moreover, 22.0% vs 19.2% underwent at least 1 prostate-specific antigen (PSA) test. The presence of an intellectual disability was associated with a higher incidence rate of symptoms (incidence rate ratio [IRR], 1.35; 95% CI, 1.28-1.43) as well as a similar rate of PSA testing (IRR, 0.99; 95% CI, 0.95-1.02), with PSA testing occurring within 90 days of a disease-suggestive symptom being less frequent in the group with intellectual disabilities at 15.8% vs 25.5% in the group without intellectual disabilities (RR, 0.66; 95% CI, 0.63-0.70).

Furthermore, 979 of those with and 19,128 of those without intellectual disabilities experienced at least 1 elevated PSA result during study follow-up. Referral within 28 days of an elevated PSA test result was less frequent in the group with intellectual disabilities at 18.2% vs 21.6% for those without intellectual disabilities (RR, 0.83; 95% CI, 0.72-0.96). A similar trend was noted for biopsy within 56 days at 5.5% vs 9.3% (RR, 0.54; 95% CI, 0.41-0.71). For those with intellectual disabilities vs those without, a diagnosis of prostate cancer occurred within 56 days of the first elevated PSA test result in 7.7% vs 15.1% (RR, 0.51; 95% CI, 0.41-0.65) compared with 6 months in 11.6% vs 22.1% (RR, 0.53; 95% CI, 0.44-0.64).

In total, 241 men with an intellectual disability and 8929 without were diagnosed with prostate cancer during follow-up. Diagnosis recorded at death was more common in the group with intellectual disabilities vs the group without intellectual disabilities (RR, 5.96; 95% CI, 2.70-11.77). Moreover, for 100% and 95% of each group, disease progression was recorded as the underlying cause of death.

“Learning disabilities are increasingly recognized as a hidden driver of cancer mortality. However, evidence on prostate cancer care in this population is limited,” Oliver Kennedy, MD, clinical lecturer at the University of Manchester and The Christie National Health Service (NHS) Foundation Trust and lead author of the study, said in a news release on the study findings.² “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.”

Patients included in the study were derived from anonymized primary care electronic health care records within the Clinical Practice Research Datalink Aurum database. These records are linked to data from the Office for National Statistics mortality records, National Cancer Registration and Analysis Service, and Hospital Episode Statistics. Almost all patients enrolled were registered with a general practice, given that registration with a general practice was a prerequisite for accessing NHS care.

Among both the group with intellectual disabilities and the group without intellectual disabilities, the median age at follow-up start was 52.0 years (SD, 18.2), with 12.1% vs 12.8% being older than 70 years. A total of 91.0% vs 85.9% of patients were White, and 26.1% vs 21.0% had an index of multiple deprivation of 5. The median follow-up was 5.4 years overall, with respective values of 4.5 and 5.5 years.

The study evaluated symptoms suggestive of prostate cancer and PSA testing. Additionally, PSA testing within 90 days of symptomatic presentation was assessed. Among those with a first PSA test result above the age-specific threshold, outcomes included suspected disease referral within 28 days, prostate biopsy within 56 days, and diagnosis within 56 days of the test.

References

1. Kennedy OJ, Chauhan U, Gorman L, 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. Published online February 20, 2026. doi:10.1016/j.euo.2026.01.004
2. Study reveals inequalities in men with learning disabilities and prostate cancer. News release. The University of Manchester. February 20, 2026. Accessed February 23, 2026. https://tinyurl.com/yn3s8k5c