Factors associated with long-distance travel among patients undergoing radical prostatectomy at a German high-volume tertiary prostate cancer centre.

PURPOSE: To evaluate determinants of long-distance travel for radical prostatectomy (RP) to a German high-volume tertiary centre.

METHODS

A total of 15,727 patients underwent RP at our high-volume tertiary centre (2019-2025). Distances from residential postal codes to our centre were computed using the Google Maps Directions API. Long-distance travel was defined a priori as > 300 km. Multivariable logistic regression analysis (MVA) was used to identify factors associated with this outcome and were complemented with sensitivity analyses that evaluated alternative distance thresholds (100-400 km), and a continuous log-transformed distance model.

RESULTS

In our cohort, 10,672 (68%) patients travelled ≤ 300 km. Those who travelled > 300 km were younger (median 64 vs.65 years), more often underwent RARP (80% vs.64%), and were more likely to have private insurance (66% vs.43%) (all p < 0.001). In MVA, younger age, private insurance, RARP, and residence in Towns and Villages (DEGURBA stratification) were independently associated with long-distance travel. These socio-demographic predictors remained highly consistent and significant across all alternative thresholds and the continuous model. Interestingly, greater distance to nearest certified PCa centre reduced the odds of travelling even farther to our centre. Disease-related variables such as EAU risk group and baseline erectile function did not achieve independent predictor status for long-distance travel.

CONCLUSIONS

Nearly one-third of patients bypassed nearby certified providers and travelled > 300 km for RP. Long-distance travel was associated primarily by non-disease-related factors, rather than disease-related, that might affect oncological or functional outcomes. Transparent outcome reporting and counselling are needed to align travel decisions with objective quality metrics.