1. South West Public Health Observatory South West Regional Public Health Group Prostate cancer in England and the South West Sean McPhail 1, Paul Eves 1, Kate Ruth 1, Tanya Cross 1 Brian Cottier 2, David Gillatt 3, and Julia Verne 1 1: South West Public Health Observatory 2: National Cancer Services Analysis Team 3: British Urological Institute sean.mcphail@swpho.nhs.uk

2. South West Public Health Observatory South West Regional Public Health Group Prostate cancer incidence and mortality Most common male cancer in England, 2 nd highest mortality Prostate cancer incidence and mortality 0 5000 10000 15000 20000 25000 30000 1995 1996 19971998199920002001200220032004 Year Number cases/deaths E&W 0 1000 2000 3000 4000 5000 Number cases/deaths SW E&W Incidence E&W Mortality SW Incidence SW Mortality Often treated by radical surgery – serious side effects

3. South West Public Health Observatory South West Regional Public Health Group Why the increase in prostate cancer incidence? “£13.99” “ Can be performed from the comfort of your own home (great if you can’t get your husband to go to the doctor) ” Levels of PSA testing static between 1996 and 1999. “The Who and Why of PSA – A Survey of PSA Requests in the South West of England” A. Richie et al., UroOncology, 1 237-242 (2001) Approx 45% rise between 2000 and 2004. “Prostate cancer in the South West: Surveys of policies and practices” K. Ruth et al., SWCIS Report, awaiting publication

4. South West Public Health Observatory South West Regional Public Health Group Prostate Biopsy (all types) in England Similar trend in number of biopsies to that in incidence. Hard to get reliable biopsy numbers (coding issues) Average age of biopsy is decreasing England data Numbers of Prostate Biopsies in England 0 5 10 15 20 25 30 35 1998199920002001200220032004 Procedures, Thousands Age Band Procedrues, Thousands 0 1 2 3 4 5 6 3540 45 50556065 70 75 8085 9095 1998 1999 2000 2001 2002 2003 2004

5. South West Public Health Observatory South West Regional Public Health Group Prostatectomy in England Majority carried out in 55-69 age bands Numbers of operations dropping in 75+ age band. Numbers of Prostatectomies 0 200 400 600 800 1000 1200 35-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485-8990-9495-99 Age Band Number of Procedures 1997-1998 1998-1999 1999-2000 2000-2001 2001-2002 2002-2003 2003-2004 Prostatectomies in England (all types) 0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 1997- 1998 1998- 1999 1999- 2000 2000- 2001 2001- 2002 2002- 2003 2003- 2004 2004- 2005 Number of operations Total numbers increasing rapidly in England

6. South West Public Health Observatory South West Regional Public Health Group Benefits and risks of Prostatectomy Reduces the chance of dying of prostate cancer… Watchful waiting % Radical Prostatectomy % Metastasis2515 PCa mortality1510 All cause mortality3227 Bill-Axelson et al., NEJM, 352:1977- 84 (2005) 695 patients Av age 64.7 years 10 year followup Impotence2565 Incontinence515 Miller et al., J. Clin. Onc., 23:2772-80 (2003)

7. South West Public Health Observatory South West Regional Public Health Group Survival in clinical vs screened prostate cancer Years after diagnosis Survival % Albertsen et al. (2005) Parker et al (2006) 55-59 60-64 65-69 70-74 Age Gleason 7

8. South West Public Health Observatory South West Regional Public Health Group New cases by Gleason score 7 6 Not known 8 5 9 0 1000 2000 3000 4000 5000 6000 1995199619971998199920002001200220032004 Stage migration Gleason score measures the divergence of the appearance of tumour cells from normal on a scale of 2-10 SW data

9. South West Public Health Observatory South West Regional Public Health Group Prostatectomy by Gleason score in SW SW data

10. South West Public Health Observatory South West Regional Public Health Group Percentage of patients treated with prostatectomy 200000-5960s70+ 6 and below43233 735202 8 and above12113 200400-5960s70+ 6 and below35172 733212 8 and above1190 Younger, and low Gleason score patients have greater rate of prostatectomy. SW data Slight decrease in fraction of patients treated with prostatectomy between 2000 and 2004.

11. South West Public Health Observatory South West Regional Public Health Group Summary The nature of prostate cancer and it’s management has changed dramatically in the last 5 years The impact on patients is uncertain Levels of PSA testing are determined by public education and local health policy We need better intelligence to understand what is going on, and to inform policy/public education

12. South West Public Health Observatory South West Regional Public Health Group Thank you sean.mcphail@swpho.nhs.uk