Explanatory notes Annual Report 2021

Definitions, inclusion criteria and explanations for trust results

Patient inclusion and data sources

Patients are eligible for inclusion in the prospective audit if they are newly diagnosed with an ICD-10 diagnostic code of “C61” (malignant neoplasm of the prostate) according to the English and Welsh cancer registry data.

The main data collection period reported here includes men diagnosed between 1st April 2019 and the 31st March 2020.

Medium-term indicators (genitourinary or gastrointestinal complications as defined below) require longer follow-up (up to two years post-treatment) so the cohort reported for these indicators are patients diagnosed between 1st January and 31st December 2018.

For this annual report, Welsh data were provided as in previous years, and the NCRAS provided data from the Rapid Cancer Registration Dataset (RCRD), which is sourced mainly from COSD and contains proxy tumour registrations, as the standard Cancer Registration data were unavailable. This dataset has been provided more quickly than has been possible in the past and includes men diagnosed up to December 2020. However, the speed of production and the pandemic has meant that several of the standard data items are unavailable or too incomplete for use for English patients. Details are published in the Methodology Supplement on our website.  

Data quality (England and Wales)

Data completeness for key items is presented: number of cancer registry records, performance status recorded, PSA completed (Wales only), Gleason score completed (Wales only), TNM completed, risk group assigned (Wales only) and stage variable assigned (England only). The denominator for the corresponding percentages is the number of relevant records in the national cancer registry.

Disease presentation (England and Wales)

Percentage of men diagnosed with metastatic prostate cancer.

This process indicator provides information on the late diagnosis of prostate cancer.

Management (Wales only)

In England, the RCRD did not contain information on Gleason grade or PSA which precluded using our risk-stratification algorithm to assign a risk group, therefore these indicators could not be estimated for English patients this year.

Percentage of men with low-risk localised prostate cancer undergoing radical prostate cancer therapy

This process indicator provides information about the potential ‘over-treatment’ of men with low-risk prostate cancer.

Percentage of men with locally advanced prostate cancer undergoing radical prostate cancer therapy 

This process indicator provides information about potential ‘under-treatment’ of men with locally advanced prostate cancer.

Treatment outcomes (England and Wales)

Percentage of patients who had an emergency readmission within 90 days of radical prostate cancer surgery  

This outcome indicator was derived from linkage with Hospital Episode Statistics Inpatient data. Emergency readmission may reflect that patients experienced a complication related to radical prostate cancer surgery after discharge from hospital. Data are presented for each radical prostatectomy centre in England.

Percentage of men experiencing at least one genitourinary (GU) complication requiring a procedural/surgical intervention within 2 years of radical prostatectomy (presented at the level of the surgical centre)

This outcome indicator was derived from linkage with Hospital Episode Statistics Inpatient data. These genitourinary complications reflect those patients who required a genitourinary procedure within 2 years of their radical prostatectomy. Data are presented for each radical prostatectomy centre in England and Wales.

Percentage of men receiving a procedure of the large bowel and a diagnosis indicating radiation toxicity (gastrointestinal [GI] complication) following radical radiotherapy

This outcome indicator was derived from linkage with Hospital Episode Statistics Inpatient data. These gastrointestinal complications reflect those patients who required a procedure of the large bowel and a diagnosis indicating radiation toxicity within 2 years of their radical radiotherapy. A toxicity event requires evidence of both a diagnostic endoscopic procedure (e.g. colonoscopy or sigmoidoscopy) in addition to a diagnostic code consistent with radiation toxicity equivalent to Grade 2 toxicity or above according to the National Cancer Institute Common Toxicity Criteria for Adverse Events (CTCAE). Data are presented for each radical radiotherapy centre in England and Wales.

Comparing outcomes by provider using risk adjustment

Funnel plots were generated for all performance indicators using control limits defining differences corresponding to two standard deviations (inner limits) and three standard deviations (outer limits) from the national average population.

Multivariable logistic regression was carried out with adjustment for patient age, socio-economic status, comorbidity and disease stage at diagnosis (for English patients) to determine adjusted treatment outcomes. 

Comorbidity was captured using the Royal College of Surgeons’ (RCS) Charlson comorbidity score using ICD-10 diagnosis codes in HES/PEDW. The Index of Multiple Deprivation (IMD) was used to categorise patients into five socioeconomic groups (1=least deprived; 5=most deprived) based on small areas in which they lived at the time of diagnosis. The five categories were fifths of the national IMD ranking of these areas. Disease status category in Wales was defined according to their TNM stage, Gleason score and PSA using a previously developed algorithm (specified on p.15 of the NPCA Annual Report 2016)

Last updated: 13 January 2022, 10:11am