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

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 Year Number cases/deaths E&W Number cases/deaths SW E&W Incidence E&W Mortality SW Incidence SW Mortality Often treated by radical surgery – serious side effects

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 “The Who and Why of PSA – A Survey of PSA Requests in the South West of England” A. Richie et al., UroOncology, (2001) Approx 45% rise between 2000 and “Prostate cancer in the South West: Surveys of policies and practices” K. Ruth et al., SWCIS Report, awaiting publication

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 Procedures, Thousands Age Band Procedrues, Thousands

South West Public Health Observatory South West Regional Public Health Group Prostatectomy in England Majority carried out in age bands Numbers of operations dropping in 75+ age band. Numbers of Prostatectomies Age Band Number of Procedures Prostatectomies in England (all types) ,000 1,500 2,000 2,500 3,000 3,500 4, Number of operations Total numbers increasing rapidly in England

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: (2005) 695 patients Av age 64.7 years 10 year followup Impotence2565 Incontinence515 Miller et al., J. Clin. Onc., 23: (2003)

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) Age Gleason 7

South West Public Health Observatory South West Regional Public Health Group New cases by Gleason score 7 6 Not known Stage migration Gleason score measures the divergence of the appearance of tumour cells from normal on a scale of 2-10 SW data

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

South West Public Health Observatory South West Regional Public Health Group Percentage of patients treated with prostatectomy s70+ 6 and below and above s70+ 6 and below 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.

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

South West Public Health Observatory South West Regional Public Health Group Thank you