Sociodemographic disparities in recorded genitourinary complications among prostate cancer survivors in England: Evidence from linked electronic health records

Abstract Purpose Genitourinary (GU) complications are frequent among prostate cancer (PCa) survivors and can substantially affect quality of life. While patient-reported outcome measures (PROMs) capture these issues in detail, they are resource-intensive and limited in scale. This study evaluated linked electronic health records (EHRs) to characterise GU complications in PCa survivors and their sociodemographic variations. Methods We conducted a population-based retrospective cohort study using linked primary care, secondary care, and cancer registry data in England. Men aged ≥ 56 years with a primary PCa diagnosis (2010–2016) who survived 18–42 months post-diagnosis were included. GU events were identified from coded symptoms/diagnoses, prescriptions, and procedures. Multivariable logistic regression assessed associations with sociodemographic and clinical factors. Results Among 10,651 survivors (mean age 72 years; 95% White; 52% without comorbidity), urinary events were recorded in 34% and sexual events in 13%. Urinary complications were more often documented in men with prior symptoms, Black ethnicity, localised disease, multimorbidity, antidepressant use or receiving androgen deprivation therapy, radiotherapy, or without recorded treatment. Sexual complications were more frequent in younger, Black men, those with prior symptoms, antidepressant use, or undergoing radical prostatectomy. Compared with PROMs, EHR-derived rates were lower. Conclusions Triangulating symptoms, prescriptions, and procedures reveals real-world patterns of GU complications and healthcare engagement often missed in trials, with recording rates varying by age, deprivation, ethnicity, prior symptoms, and treatment type. Implications for Cancer Survivors: Many GU complications are under-recorded in structured EHRs, reflecting differences in help-seeking or reporting. Improving coding and integrating PROMs could enhance data completeness for research, monitoring, and equitable, patient-centered survivorship care.