Prostate cancer in England and the South West

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@swpho.nhs.uk South West Public Health Observatory South West Regional Public Health Group Prostate cancer incidence and mortality Prostate cancer incidence and mortality 30000 Number cases/deaths E&W 25000 20000 15000 10000 5000 0 1997 1998 1999 2000 2001 2002 2003 1995 1996 2004 4000 3000 2000 1000 0 Number cases/deaths SW 5000 E&W Incidence E&W Mortality SW Incidence SW Mortality Year Most common male cancer in England, 2nd highest 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? 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 can’t get your husband to go to the doctor)” South West Public Health Observatory South West Regional Public Health Group Prostate Biopsy (all types) in England Numbers of Prostate Biopsies in England 35 Procedures, Thousands 30 25 20 15 10 5 0 6 5 4 3 2 1 0 90 75 80 35 40 45 50 55 60 65 70 85 95 1998 1999 2000 2001 2002 2003 2004 1998 1999 2000 2001 2002 2003 2004 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 Procedrues, Thousands Age Band South West Public Health Observatory South West Regional Public Health Group Prostatectomy in England Prostatectomies in England (all types) 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 0 1997- 1998- 1999- 2000- 2001- 2002- 2003- 20041998 1999 2000 2001 2002 2003 2004 2005 Number of operations Total numbers increasing rapidly in England Numbers of Prostatectomies 1200 Number of Procedures 1000 800 600 400 200 0 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99 1997-1998 1998-1999 1999-2000 2000-2001 2001-2002 2002-2003 2003-2004 Majority carried out in 55-69 age bands Numbers of operations dropping in 75+ age band. Age Band 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 Radical waiting % Prostatectomy % Metastasis PCa mortality All cause mortality 25 15 32 15 10 27 Bill-Axelson et al., NEJM, 352:197784 (2005) Miller et al., J. Clin. Onc., 23:2772-80 (2003) 695 patients Av age 64.7 years 10 year followup Impotence Incontinence 25 5 65 15 South West Public Health Observatory South West Regional Public Health Group Survival in clinical vs screened prostate cancer Age Gleason 7 55-59 60-64 65-69 70-74 Survival % Albertsen et al. (2005) Years after diagnosis Parker et al (2006) South West Public Health Observatory South West Regional Public Health Group Stage migration Gleason score measures the divergence of the appearance of tumour cells from normal on a scale of 2-10 New cases by Gleason score 6000 5000 4000 9 3000 8 Not known 7 6 5 1996 1997 1998 1999 2000 2001 2002 2003 2004 2000 1000 0 1995 SW data South West Public Health Observatory South West Regional Public Health Group Prostatectomy by Gleason score in SW Prostatectomy by Gleason score in SW Number of operations per year 180 160 140 120 100 80 60 40 20 0 2 3 4 5 6 7 8 9 10 Gleason score 1998 1999 2000 2001 2002 2003 SW data South West Public Health Observatory South West Regional Public Health Group Percentage of patients treated with prostatectomy 2000 6 and below 7 8 and above 00-59 43 35 12 60s 23 20 11 70+ 3 2 3 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 2004 6 and below 7 8 and above 00-59 35 33 11 60s 17 21 9 70+ 2 2 0 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 sean.mcphail@swpho.nhs.uk South West Public Health Observatory South West Regional Public Health Group