1. 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)

2. 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?

3. 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)

4. Crude incidence rates 2002

5. Standardised registration ratios English Regions 2002 England

6. Age standardised incidence and mortality rates of prostate cancer in the South West 1993-2002

7. Incidence rates by age band 1992-2002 in the South West

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

9. Male population of South West

10. South Wiltshire PCTWest of Cornwall PCT

11. Standardised Incidence Ratio in PCTs 2000-2002 compared to England

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

13.  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)

14. Number of total prostatectomies / cystectomies carried out to treat cancer by Trust in 2002. Excludes endoscopic resections.

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

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

17. % of Surgery by Gleason score at diagnosis 1998-2002

18. 0 5 10 15 20 25 30 35 40 0-6465-7475+ % undergoing surgery 1-56-10unknownGleason score at diagnosis Proportion of patients in 2002 having open prostatectomy or endoscopic resection by age group and Gleason score at diagnosis

19. 5 year relative survival, diagnosed 1997-1999

20. 5 year survival, diagnosed 1997-1999 Age <75, gleason score at diagnosis 5, 6 or 7

21. 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 out244534 Number returned135

22. Number of PSA tests carried out

23. % of positive tests (level according to PCRMP)

24. Source of PSA test (2004)

25. 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

26. 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.