Prostate news article, July 2007
CHIEF MEDICAL OFFICER'S ANNUAL REPORT HIGHLIGHTS 'CHANGING TRENDS IN PROSTATE CANCER' CMO Annual report, 2006 Forwarded by: John Anderson, CEO Prostate UK |
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The Chief Medical Officer, Sir Liam Donaldson has recently published his Annual Report for 2006, and of particular interest the report contains a series of case-studies, taken from each region of England, which look at a particular health issue related to that area. This will then be revisited in the following year's report, where progress is reviewed.
This year's focus for the South West is 'changing trends in prostate cancer' which looks at increased demand for testing, implementation of standards for testing and treatment, changing pathology reporting practice and demands on health service resources. The case study is copied below for your information.
The full report can be found at:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/AnnualReports/DH_076817
This year’s focus Changing trends in prostate cancer
Prostate cancer is the second most commonly diagnosed cancer and the second most common cause of cancer death in men in England and Wales. It is an emerging public health challenge due to increased patient demand for testing, variable implementation of quality standards for testing and treatment, changing pathology reporting practice and increasingly significant demands on health service resources.
The South West has the highest age-standardised incidence rate of the disease in England, with 4,000 men diagnosed and 1,000 deaths in the South West per annum; an increase of approximately 65% over the last 10 years compared with a 50% increase nationally during the same period. There is significant sub-regional variation in the South West, with some primary care trusts experiencing little change and others witnessing threefold increases.
The rapid increase in the incidence of prostate cancer is largely due to rising patient demand for prostate specific antigen testing. This is supported by the fact that incidence rates are higher in more affluent areas, where men may be more likely to request a test. A regional survey showed a 45% rise in the frequency of testing between 2000 and 2004. This mirrors two national surveys, which saw a 39% rise in testing between 2000/01 and 2003/04. Estimates based on national surveys indicate that more than 1.5 million tests are carried out in England every year. Of these, at least a quarter of a million (one-sixth) are screening tests in asymptomatic men. The national surveys in 2000/01 and 2003/04 revealed variations in the type of tests used: at that time only 70% were of a standard judged acceptable by the Prostate Cancer Risk Management programme and only 5% of laboratories completely followed its guidance on testing. In 2005, an audit of 17 laboratories by the South West Public Health Observatory showed that only one laboratory (out of 12 that responded) was not compliant with the Prostate Cancer Risk Management programme guideline on calibration of prostate specific antigen tests used.
Men with a positive test are offered a biopsy, and the number of biopsies recorded in the South West has doubled in six years. Clinical data combined with cancer registry information have shown that there has been a significant shift in the grading of pathological samples, which may affect treatment decisions. Men who would previously have been diagnosed with low-aggression tumours are now reported as having moderately aggressive tumours.
The Prostate Cancer Risk Management programme recommends that patients with a life expectancy of over a decade be offered a choice between radical prostatectomy, radical radiotherapy or active surveillance.
The risk of surgical morbidity resulting from a prostatectomy is high at 16.5%, with a 0.3% risk of mortality. In addition, men who have undergone the procedure are at risk of long-term side effects. At 65% and 15% respectively, rates of impotence and incontinence among men who have undergone a prostatectomy are approximately three times higher than among sufferers who have received less radical treatment.
In the South West, the number of radical prostatectomies has increased tenfold over the last 10 years. The latest available Hospital Episode Statistics data show that in the financial year 2004/05, only three of 14 NHS Trusts in the South West region performed the minimum number of 50 procedures recommended by the National Institute for Health and Clinical Excellence’s 2002 guidance on urological cancer, potentially affecting post-operative outcome for patients.
To improve understanding of the changing trends in prostate cancer and the implications for health services, the South West region created the Urological Cancer Observatory, which merges health service, cancer registry and clinical data. This is being used to inform the development of the National Institute for Health and Clinical Excellence clinical guideline on diagnosis and treatment of prostate cancer.