Prostate cancer in England and the South West

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Prostate cancer in England and the South West
Sean McPhail1, Paul Eves1, Kate Ruth1, Tanya
Cross1 Brian Cottier2, and Julia Verne1 1 South
West Public Health Observatory 2 National Cancer
Services Analysis Team sean.mcphail_at_swpho.nhs.uk
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Prostate cancer incidence and mortality
Prostate cancer incidence and mortality
30000
5000
25000
4000
EW Incidence
20000
EW Mortality
3000
EW
SW
15000
Number cases/deaths
Number cases/deaths
SW Incidence
2000
10000
SW Mortality
1000
5000
0
0
1996
1997
1998
1999
2000
2001
2002
2003
2004
1995
Year

• Most common male cancer in England, 2nd highest
  mortality

• Often treated by radical surgery serious side
  effects

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Why the increase in prostate cancer incidence?

• 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

13.99 Can be performed from the comfort of
your own home (great if you cant get your
husband to go to the doctor)
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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
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Prostatectomy in England
Prostatectomies in England (all types)

• Total numbers increasing rapidly in England

4,000
3,500
3,000
2,500
Number of operations
2,000
1,500
1,000
500
0
1997-
1998-
1999-
2000-
2001-
2002-
2003-
2004-
1998
1999
2000
2001
2002
2003
2004
2005

• Majority carried out in 55-69 age bands
• Numbers of operations dropping in 75 age band.

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Benefits and risks of Prostatectomy

• Reduces the chance of dying of prostate cancer

695 patients Av age 64.7 years 10 year followup
Bill-Axelson et al., NEJM, 3521977-84 (2005)
Miller et al., J. Clin. Onc., 232772-80 (2003)
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Survival in clinical vs screened prostate cancer
Gleason 7
Age
55-59
65-69
70-74
60-64
Survival
Albertsen et al. (2005)
Years after diagnosis
Parker et al (2006)
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Stage migration

• Gleason score measures the divergence of the
  appearance of tumour cells from normal on a scale
  of 2-10

SW data
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Prostatectomy by Gleason score in SW
SW data
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Percentage of patients treated with prostatectomy

• Younger, and low Gleason score patients have
  greater rate of prostatectomy.

• Slight decrease in fraction of patients treated
  with prostatectomy between 2000 and 2004.

SW data
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Summary

• The nature of prostate cancer and its 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

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Thank yousean.mcphail_at_swpho.nhs.uk