Trends in prostate cancer and its management in the South West Region, Hampshire and the Isle of Wight Christine Harling Julia Verne (SWPHO) Roy Maxwell (SWPHO) Kate Ruth (SWPHO) Tanya Cross (SWPHO) Richard Martin (Bristol University)

Aims How does prostate cancer incidence in the South West compare with the rest of the country? What are the trends in incidence and mortality What are the relationships between prostate cancer and deprivation? What is the impact of guidance on the management of prostate cancer? What are the trends in PSA testing and what impact has this had on incidence rates?

Relevant guidance Prostate Cancer Risk Management programme (Primary Care) NICE – Improving Outcomes in Urological Cancers (Secondary Care) Guidelines on the Managements of Prostate Cancer (BAUS) NICE – clinical guidelines for prostate cancer (in progress)

Crude incidence rates 2002

Standardised registration ratios English Regions 2002 England

Age standardised incidence and mortality rates of prostate cancer in the South West

Incidence rates by age band in the South West

Reasons for the increase? More prostate cancer Aging population More men requesting PSA tests More GPs offering PSA tests

Male population of South West

South Wiltshire PCTWest of Cornwall PCT

Standardised Incidence Ratio in PCTs compared to England

Incidence / mortality of prostate cancer in 42 PCTs in SW England according to the income domain of IMD 2004.

 Importance of informed choice for patients when considering possible management options.  Radical prostatectomy should be discussed with men whose tumours are confined to the prostate and who would be expected to live for more than 10 years if they did not have prostate cancer.  Radical prostatectomy should be carried out by specialist multidisciplinary urological cancer teams which carry out at least 50 radical operations (prostatectomies and cystectomies) for prostate or bladder cancers per year. NICE guidance (current)

Number of total prostatectomies / cystectomies carried out to treat cancer by Trust in Excludes endoscopic resections.

Number of radical prostatectomies carried out to treat cancer by Trust in 1993* and 2002.

Proportion of patients in the South West having radical surgery by age group

% of Surgery by Gleason score at diagnosis

% undergoing surgery unknownGleason score at diagnosis Proportion of patients in 2002 having open prostatectomy or endoscopic resection by age group and Gleason score at diagnosis

5 year relative survival, diagnosed

5 year survival, diagnosed Age <75, gleason score at diagnosis 5, 6 or 7

Questionnaires Sent to labs, PCTs and urologists Awareness of PCRMP Influence of PCRMP on practices Number of tests and % positive Primary / secondary care testing Responses so farLabsPCTsUrologists Number sent out Number returned135

Number of PSA tests carried out

% of positive tests (level according to PCRMP)

Source of PSA test (2004)

Number returning questionnaire13 Number noticing an increase in patients referred to prostate clinics over the past 5 years 12 Number noticing no change1 Number noticing an increase in symptomatic patients 4 Number noticing an increase in patients with no symptoms 12 Number whose network PSA testing policy is NOT based on PCRMP 3 Responses from urologists

Summary  Evidence from questionnaires adds to evidence that the recent increase in prostate cancer incidence is due to an increase in PSA testing  Incidence of prostate cancer (and also rate of PSA testing?) is higher in affluent areas  Rates of radical treatment are increasing, particularly in younger age groups. Survival appears to be better in those that had radical prostatectomy although there is no data on quality of life.