P. Cathcart

The first national clinical audit of prostate cancer care.

Department of Urology, University College Hospital London & St. Bartholomews Hospital London & Centre for Experimental cancer Medicine, Barts Cancer Institute, *The Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, †Eastern Cancer Registration & Information Centre, ‡Primary Care Unit, University of Cambridge, §Department of radiation oncology, University College Hospital London, and ¶Department of Oncology, University of Cambridge, Cambridge, UK

The National Prostate Cancer Audit - introducing a new generation of cancer audit.

* The Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK yDepartment of Urology, University College Hospital London and St Bartholomew’s Hospital London and Centre for Experimental Cancer Medicine, Bart’s Cancer Unit, London, UK zDepartment of Oncology, University College Hospital, London, UK xDepartment of Oncology, University of Cambridge, Cambridge, UK { Eastern Cancer Registration and Information Service (ECRIC), UK

415 Comparison of radical treatment and mortality in patients with non-metastatic prostate cancer in England and USA

INTRODUCTION AND OBJECTIVES: Prostate-cancer mortality in the USA is reported to be amongst the lowest in the world. Given known differences in management of prostate cancer patients, this paper compares risk-adjusted prostate-cancer mortality in England and the USA. METHODS: Patients diagnosed with non-metastatic prostate cancer between 2004 and 2008 were identified using English hospital admission records linked to national cancer registry data, and the American Surveillance, Epidemiology and End Results programme. Complete data were available for 222,163 patients. Patients were stratified into low, intermediate and high-risk groups according to disease characteristics. Competing-risks survival analyses were used to estimate hazard ratios (HR) adjusted for age, ethnicity, year of diagnosis, Gleason score and tumour stage. RESULTS: In comparison to patients in the USA, English patients were more likely to present at an older age (70-79 years: England 44.2%, US 29.3%, p<0.001), with higher clinical tumour stage (cT3-4: England 25.1%, US 8.6%, p<0.001) and higher Gleason score (GS 8-10: England 20.7%, USA 11.2%, p<0.001). They were also less likely to receive radical therapy, with greatest difference amongst patients with high-risk disease (England 30%, USA 83%, p<0.001). English patients were more likely to die of prostate-cancer (HR 1.9, 95% CI 1.7-2.0, p<0.001). However, this difference was no longer statistically significant when it was also adjusted for radical therapy (HR 1.0, 95% CI 1.0-1.1, p1⁄40.3). CONCLUSIONS: After risk-adjustment, prostate-cancer mortality is significantly higher in England compared to the USA for men with intermediate and high-risk disease. This difference appears to be explained by less frequent use of radical therapy in England.