1. Prostate cancer and socio-economic deprivation When PCTs are ranked according to their income score using the Indices of Multiple Deprivation (IMD)* there is a positive association between income and the incidence rate of prostate cancer (figure 3). There is no evidence of an association with mortality (figure 3). This indicates that affluent men are more proactive in requesting PSA tests but that early diagnosis in a population as a whole does not necessarily confer reduced mortality. In 2002 the Department of Health published the “Prostate Cancer Risk Management Programme” with the aim of ensuring that all primary care providers and their patients have the information they need in order to make choices about PSA testing and prostate cancer treatment. *PCT scores produced by the Healthcare Commission based on the IMD2004 from the Office of the Deputy Prime Minister. South West Public Health Observatory Cancer Intelligence Service Trends in prostate cancer and its management in the South West Region, Hampshire and the Isle of Wight C Harling, J Verne, R Maxwell, K Ruth, T Cross 0117 970 6474 www.swpho.nhs.uk Background In South West England, prostate cancer is the most commonly diagnosed cancer in men and the second most common cause of cancer death. The UK does not have a screening programme for prostate cancer although men may ask their GP for a test to detect high levels of prostate specific antigen (PSA) which may indicate that cancer is present. Some types of prostate cancer grow slowly and will not become a problem during a man’s lifetime but other types are more aggressive. As surgery and radiotherapy can result in unpleasant side effects, men with a high PSA need be aware of the advantages and disadvantages of confirming a diagnosis of prostate cancer and undergoing treatment. Figure 3. Incidence of prostate cancer in 42 PCTs in SW England according to the income domain of IMD 2004. Figure 4. Mortality from prostate cancer in 42 PCTs in SW England according to the income domain of IMD 2004. Aims To examine the trends in incidence and mortality for prostate cancer in the South West and the association with age and socio- economic deprivation. To investigate relationships between age and stage at diagnosis and treatment by radical prostatectomy. To establish whether there is a consistent approach to the diagnosis and treatment of prostate cancer across the region, in line with national guidance. Figure 1. Age standardised incidence and mortality rates of prostate cancer in the CIS area 1993-2002 Figure 2. Standardised Incidence Ratio in PCTs 2000-2002 compared to England There has been a large increase in the incidence of prostate cancer over the past 10 years, while mortality rates have remained largely unchanged (figure 1). The increase has been most noticeable in men aged under 75 (see figure 5). The increase has not been evenly distributed across the region, with PCTs in Dorset and Hampshire generally having the highest incidence (figure 2). Conclusions The incidence of prostate cancer is increasing in the South West but not uniformly across PCTs. The proportionate increase in incidence is greatest in younger age groups. Incidence rates are highest in the least deprived PCTs. There is no impact of deprivation on mortality. Radical prostatectomy rates are increasing, particularly in the under 65 age group. Very few Trusts carry out more than 50 prostatectomies and cystectomies each year, as recommended by NICE (although the figures presented here do not include operations carried out for reasons other than to treat cancer). Further work is needed to determine the extent of awareness of Prostate Cancer Risk Management and also to look at laboratory data on numbers and positive rates of PSA tests. Questionnaires have been sent to labs, PCTs and urologists. Figure 7. Proportion of patients having radical surgery by age group Age at diagnosis Over the past 10 years, the incidence rate in men aged under 75 has shown a proportionately greater increase than in older men. Figure 5. Incidence rate by age band 1992-2002 Treatment NICE Guidance states that 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 not be carried out by specialist multidisciplinary urological cancer teams which carry out fewer than 50 radical operations (prostatectomies and cystectomies) for prostate or bladder cancers per year. Figure 6. Number of total prostatectomies / cystectomies carried out to treat cancer by Trust in 2002. Excludes endoscopic resections. NICE guidance recommendation.