National Prostate Cancer Audit Heather Payne, NPCA Oncological Clinical Lead Consultant Clinical Oncologist, UCL

Prostate Cancer Most common solid cancer in men & second most common cause of cancer death in UK men, after lung cancer 40,000 new cases and 10,000 deaths/year – 110 men are diagnosed each day (30 deaths/day) Variable course in different patients – High risk = aggressive & fast growing (clinically significant) vs low risk = localised & slow growing (clinically insignificant disease) Cancer Research UK. Prostate cancer statistics, 2014

Staging of prostate cancer

Prostate Cancer Disease Staging (MDT) Multi-disciplinary Team Guidance for Managing Prostate Cancer British Association of Urological Surgeons (BAUS) Section of Oncology British Uro-oncology Group (BUG) British Prostate Group (BPG)

Prostate Cancer (2) An increasing number of men are living with a diagnosis of low-risk localised disease without evidence of spread beyond the prostate – A key concern is the potential for patients with low-risk disease to undergo radical treatments Men with high-risk localised or locally advanced disease are more likely to develop progression and to die of their disease – May not be getting the radical treatments (multimodal therapy) that they need

* High-risk localised prostate cancer is also included by NICE for the same therapy options as locally advanced prostate cancer

Background Healthcare Quality Improvement Partnership (HQIP) established in 2008 to promote quality in healthcare – Increase the impact of clinical audit on healthcare quality HQIP set up the National Clinical Audit and Patient Outcomes Programme (NCAPOP) – Commissions large scale audits Acute, Cardiac, Long-term conditions, Mental health, Older people, Women & Children Cancer – bowel, head & neck, oesophogastric, lung

National Prostate Cancer Audit (NPCA) Commissioned by HQIP as part of the NCAPOP programme Contract awarded to the Clinical Effectiveness Unit, RCS Managed as partnership with BAUS, BUG and NCRS Audit initiated in April 2013, minimum of 5 years

Governance Structure Project Team: undertake all activities required to deliver the audit (based in CEU of RCS) Project Board: oversee the delivery of the contract Clinical Reference Group: support implementation of the audit

Clinical Reference Group Same Chair as NCIN Urology Site-specific CRG (Roger Kockelbergh) -> avoid overlap and ensure cross fertilisation Members from – BAUS – BUG – BAUN – RCGP – Patient and public reps (Prostate Cancer UK, Tackle Prostate Cancer) – NCIN – National Peer Review – National Commissioning Board – Specialised Urology CRG, NHS England

National Prostate Cancer Audit Aim: – assess the process of care and outcomes in men diagnosed with prostate cancer in England and Wales Key audit topics: – service delivery and organisation of care – characteristics of newly-diagnosed prostate cancer, how the cancer was detected and the referral pathway – diagnostic and staging process – planning of initial treatment & treatments received – patient experience and health outcomes 18 months after diagnosis – overall and disease-free survival – feasibility of a PSA testing audit in primary care

Audit Topics and Objectives Audit Topics – For each trust we will describe: Presenting stage and risk stratification Prostate cancer treatments received Patient experience and quality of life 18 months after radical prostate cancer therapy Audit Objectives – Report Use of active surveillance for men with low risk prostate cancer Use of appropriate radical therapy for high risk prostate cancer Outcomes following radical treatments Use of PSA testing

Key Objectives: Year 1 Carry out an organisational audit of prostate cancer care in England and Wales Analyse existing data to provide comparative background data for the audit Design a national data collection system and a short and simple minimum dataset for the prospective audit Scoping of feasibility study for audit of PSA testing in primary care

Published on the 10 th November 2014 Available for download from our website

Key Objectives: From Year 2 Collect prospective data from each newly-diagnosed patient discussed at a MDT meeting Initiate data collection in April 2014 and will continue throughout the audit Data collection started in England in April Data collection in Wales delayed until April 2015

Key Objectives: From Year 3 Collect PROMs and PREMs from all patients with localised prostate cancer who are candidates for radical treatment 18 months after diagnosis Data collection will start in October 2015 and will continue throughout the audit

What improvements are anticipated? Appropriate use of active surveillance for men with low risk prostate cancer based on patient choice Appropriate use of multimodality for men with high risk or locally advanced prostate cancer Improved safety and toxicity profile of prostate cancer therapy Reduced variation in prostate cancer therapy across NHS trusts Findings from the feasibility study of PSA testing will guide the planning of a national approach for the diagnosis of prostate cancer in line with men’s preferences

Thank you! The success of the NPCA is dependent on your continuing support

‘A national clinical audit of prostate cancer care will improve clinical practice and patient outcomes, and ultimately save lives. The success of this audit has our full support and commitment.’ − Adrian Joyce, President of BAUS (until June 2014) ‘BUG supports NPCA as it is a fantastic opportunity to provide accurate data directly from MDTs with minimal administrative burden on staff and patients alike. This will improve the quality of care and outcome of patients nationwide.’ − Simon Russell, Secretary of BUG