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Individuals with index diagnoses of intermediate- or high-risk PCa (February 2009\u2013August 2022) who were receiving PCa-directed definitive treatment (radical prostatectomy or radiotherapy) were included. CALD status was defined as being born in non-English-speaking countries versus mainly English-speaking countries (MESC) or Australia. Additionally, using preferred spoken language, CALD individuals were categorized into English-speaking CALD and non-English-speaking CALD individuals. Binary logistic regression was used to examine associations between CALD status and definitive treatment delay (&gt;\u200990\u00a0days from diagnosis to treatment). Mediation analysis was undertaken using generalized structural equation modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 13,625 participants, 2,455 were from CALD backgrounds (18%). Nine per cent of 2,455 CALD individuals preferred speaking languages other than English. Median days to definitive treatment were longer for non-English-speaking CALD (92) compared to Australian-born (64) individuals. Non-English-speaking CALD individuals experienced significantly (adjusted odds ratio\u2009=\u20092.54, 95% confidence interval\u2009=\u20091.92\u20133.38) greater treatment delay than Australian-born individuals, adjusted for sociodemographic and clinical factors. The association between CALD status and definitive treatment delay was fully mediated by non-English-speaking CALD individuals being diagnosed mostly at public institutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Non-English-speaking-CALD individuals experienced greater delays in the definitive treatment of intermediate- and high-risk PCa than Australian-born individuals, which is largely explained by the type of diagnosing health institution. More timely treatment for non-English-speaking-CALD will require less delay in public hospitals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10552-025-02074-4","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T05:15:03Z","timestamp":1760073303000},"page":"1975-1988","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The effect of cultural and linguistic diversity on the timeliness of prostate cancer treatment: a registry-based retrospective cohort study"],"prefix":"10.1007","volume":"36","author":[{"given":"Koku Sisay","family":"Tamirat","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael James","family":"Leach","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan","family":"Papa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Millar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eli","family":"Ristevski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"issue":"3","key":"2074_CR1","first-page":"209","volume":"71","author":"H Sung","year":"2021","unstructured":"Sung H, Ferlay J, Siegel RL, Laversanne M et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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