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Current national trends in the management of locally advanced prostate cancer with radical therapies: Results from the English National Prostate Cancer Audit
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
768
Current national trends in the management of locally advanced prostate cancer with radical therapies: Results from the English National Prostate Cancer Audit Eur Urol Suppl 2017; 16(3);e1330
Sujenthiran A.1, Nossiter J.1, Charman S.1, Aggarwal A.1, Cathcart P.2, Payne H.3, Clarke N.4, Van Der Meulen J.1 1
Royal College of Surgeons, Clinical Effectiveness Unit, London, United Kingdom, 2Guy's and St Thomas' NHS Foundation Trust, Dept. of Urology, London, United Kingdom, 3University College London Hospitals, Dept. of Oncology, London, United Kingdom, 4The Christie and Salford Royal NHS Foundation Trusts, Dept. of Urology, London, United Kingdom INTRODUCTION & OBJECTIVES: Multimodal radical treatment can achieve favourable outcomes in men with locally advanced prostate cancer (PCa). However, some patients may be “under-treated” and not receive potentially beneficial radical therapies that may offer a long-term cure. To date there is limited information regarding the current trends in the management of men with locally advanced PCa on a national level. The objective of this study was to evaluate current practice with regard to the potential “under-treatment” of men with locally advanced prostate cancer and to assess variation amongst regional providers of prostate cancer care in England. MATERIAL & METHODS: A prospective population-based study was performed using data from the National Prostate Cancer Audit (NPCA) for men diagnosed with PCa from April 1 2014 – March 31 2015. Data-linkage was performed with the National Cancer Data Repository, National Radiotherapy Data-set and the Hospital Episode Statistics database. Men with locally advanced disease were identified using the “NPCA risk stratification algorithm” that incorporated Gleason score, PSA and TNM stage. Radical therapies were defined as external beam radiotherapy (EBRT), radical prostatectomy, brachytherapy and HIFU. Unadjusted funnel plots were used to determine the variation in the use of radical therapies for locally advanced disease across 48 specialist multidisciplinary teams (MDTs) in England. RESULTS: 11,957 men were diagnosed with locally advanced PCa between April 1 2014 – March 31 2015. Overall 61% (range 34 - 84%) of men underwent some form of radical therapy. EBRT (42% (range 20 - 61%)) and radical prostatectomy (18% (range 4-36%)) were the commonest treatment modalities. Brachytherapy (1% (range 0-13%) and HIFU (<1%) were rarely used. Unadjusted funnel plots demonstrated a wide variation in overall proportion of men with locally advanced PCa receiving radical treatment amongst the 48 specialist MDTs. CONCLUSIONS: The overall proportion of men with locally advanced disease potentially being “undertreated” is 39%. This is an improvement compared to a previous analysis of men diagnosed from 2010-13 (53%). Future work will adjust for case-mix factors to further explore the variation seen across specialist MDTs in England.
Eur Urol Suppl 2017; 16(3);e1330 Powered by TCPDF (www.tcpdf.org)
768
Current national trends in the management of locally advanced prostate cancer with radical therapies: Results from the English National Prostate Cancer Audit Eur Urol Suppl 2017; 16(3);e1330
Sujenthiran A.1, Nossiter J.1, Charman S.1, Aggarwal A.1, Cathcart P.2, Payne H.3, Clarke N.4, Van Der Meulen J.1 1
Royal College of Surgeons, Clinical Effectiveness Unit, London, United Kingdom, 2Guy's and St Thomas' NHS Foundation Trust, Dept. of Urology, London, United Kingdom, 3University College London Hospitals, Dept. of Oncology, London, United Kingdom, 4The Christie and Salford Royal NHS Foundation Trusts, Dept. of Urology, London, United Kingdom INTRODUCTION & OBJECTIVES: Multimodal radical treatment can achieve favourable outcomes in men with locally advanced prostate cancer (PCa). However, some patients may be “under-treated” and not receive potentially beneficial radical therapies that may offer a long-term cure. To date there is limited information regarding the current trends in the management of men with locally advanced PCa on a national level. The objective of this study was to evaluate current practice with regard to the potential “under-treatment” of men with locally advanced prostate cancer and to assess variation amongst regional providers of prostate cancer care in England. MATERIAL & METHODS: A prospective population-based study was performed using data from the National Prostate Cancer Audit (NPCA) for men diagnosed with PCa from April 1 2014 – March 31 2015. Data-linkage was performed with the National Cancer Data Repository, National Radiotherapy Data-set and the Hospital Episode Statistics database. Men with locally advanced disease were identified using the “NPCA risk stratification algorithm” that incorporated Gleason score, PSA and TNM stage. Radical therapies were defined as external beam radiotherapy (EBRT), radical prostatectomy, brachytherapy and HIFU. Unadjusted funnel plots were used to determine the variation in the use of radical therapies for locally advanced disease across 48 specialist multidisciplinary teams (MDTs) in England. RESULTS: 11,957 men were diagnosed with locally advanced PCa between April 1 2014 – March 31 2015. Overall 61% (range 34 - 84%) of men underwent some form of radical therapy. EBRT (42% (range 20 - 61%)) and radical prostatectomy (18% (range 4-36%)) were the commonest treatment modalities. Brachytherapy (1% (range 0-13%) and HIFU (<1%) were rarely used. Unadjusted funnel plots demonstrated a wide variation in overall proportion of men with locally advanced PCa receiving radical treatment amongst the 48 specialist MDTs. CONCLUSIONS: The overall proportion of men with locally advanced disease potentially being “undertreated” is 39%. This is an improvement compared to a previous analysis of men diagnosed from 2010-13 (53%). Future work will adjust for case-mix factors to further explore the variation seen across specialist MDTs in England.
Eur Urol Suppl 2017; 16(3);e1330 Powered by TCPDF (www.tcpdf.org)