Background: Prostate cancer (PCa) is the most commonly diagnosed cancer among men in the UK. Despite efforts to improve outcomes, evidence shows persistent sociodemographic disparities across the pathway from diagnosis through treatment to long-term survivorship. Linked electronic health records (EHRs) offer opportunities to examine real-world cancer care across diverse populations.

Aim: To leverage large-scale linked EHRs to investigate sociodemographic disparities by age, ethnicity, deprivation and region in PCa diagnosis, treatment, and survivorship across England.

Methods: The research drew on multiple national EHR sources: Clinical Practice Research Datalink (CPRD) GOLD and Aurum, linked with Hospital Episode Statistics (HES) and National Cancer Registration and Analysis Service (NCRAS) data, supplemented by OpenSAFELY and OpenPrescribing platforms. Six interrelated studies were structured around the diagnostic, treatment, and survivorship phases of the PCa care pathway.

Results:

Diagnostic phase: The quality of PCa diagnosis recording varied across EHR sources, with CPRD Aurum showing slightly higher quality than CPRD GOLD. Men aged 80 and over had 3.2 times higher odds of being diagnosed with locally advanced PCa and 12.9 times higher odds of advanced disease compared to men aged 60–69. Men living in the most deprived areas had 1.25 times higher odds of advanced-stage diagnosis, and those in the East Midlands had 1.4 times higher odds after adjusting for comorbidities.

Treatment phase: Men aged ≥80 were 3.3 times less likely to receive radical treatment and 2.5 times more likely to receive androgen deprivation therapy (ADT) or have no treatment recorded. Asian men with locally advanced disease had 1.8 times higher odds of no recorded treatment compared to White men. Regionally, men in the North East and Yorkshire & Humber had 1.43 times lower odds of curative treatment. National prescribing data from 2000–2024 showed ADT prescriptions were highest in men aged ≥75 and those in the most deprived quintile. The COVID-19 pandemic caused a 1.25 times reduction in short-interval ADT prescriptions and accelerated the switch to 6-monthly formulations.

Survivorship phase: Among 10,651 men, only 34% had a recorded urinary complication and 13% a sexual complication within 18–42 months post-diagnosis, compared to 50–80% prevalence in patient-reported studies. Black men had 1.5 times higher odds of both complications being recorded, while men from deprived areas had 1.43 times lower odds. Prior urinary or sexual symptoms strongly predicted post-treatment complications.

Conclusions: Linked EHRs provide crucial insight into how sociodemographic factors shape PCa care in England. They also reveal limitations in EHR data capture, emphasising the need for improved real-world data collection to support equitable cancer services.