Explanatory notes Annual Report 2023

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.

For this annual report, Welsh data were provided as in previous years, and the National Cancer Registration and Analysis Service (NCRAS) provided English data from the Rapid Cancer Registration Dataset (RCRD), which is sourced mainly from Cancer Outcomes and Services Dataset (COSD) and contains proxy tumour registrations, as well as the standard Cancer Registration data: National Cancer Registration Dataset (NCRD).

For the first time since the NPCA Annual Report 2020, we report results from all six of our performance indicators for both England and Wales, using the most recently available data to the audit (Table 1). Four performance indicators:

• proportion of men with low-risk localised cancer undergoing radical prostate cancer treatment
• proportion of men with high-risk/locally advanced disease undergoing radical prostate cancer treatment
• proportion of patients experiencing at least one genitourinary (GU) complication requiring a procedural/surgical intervention within 2 years of radical prostatectomy
• proportion of patients receiving a procedure of the large bowel and a diagnosis indicating radiation toxicity up to 2 years following radical prostate radiotherapy (RT)

require risk stratification using the Gleason score, which is not currently available in the RCRD used by the NPCA for recent Annual Reports (2021 and 2022). Therefore, to include these, we have used the NCRD in England. The most recently available data to the audit from the NCRD in England is between 1st April 2020 and 31st March 2021.

In Wales, the data we receive includes the Gleason score, and the most recently available data to the audit covers patients newly diagnosed with prostate cancer between 1st April 2021 and 31st March 2022.

*NCRD: National Cancer Registration Dataset;
**Cancer Network Information System Cymru;
*** RCRD: Rapid Cancer Registration Dataset

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 undergoing treatment during the period 1st September 2019 to 30th August 2020.

Data quality

Data completeness for key items is presented: number of cancer registry records, performance status recorded, PSA completed, Gleason score completed and TNM completed. The denominator for the corresponding percentages is the number of relevant records in the national cancer registry.

Disease presentation

Percentage of men diagnosed with metastatic prostate cancer.

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

Management

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

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

Percentage of men with high-risk/locally advanced prostate cancer undergoing radical prostate cancer treatment 

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

Treatment outcomes

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 Admitted Patient Care (HES APC) data for England and Patient Episode Database for Wales (PEDW) for Wales. 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 and Wales.

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 Admitted Patient Care (HES APC) data for England and Patient Episode Database for Wales (PEDW) for Wales. 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 prostate radiotherapy

This outcome indicator was derived from linkage with Hospital Episode Statistics Admitted Patient Care (HES APC) data for England and Patient Episode Database for Wales (PEDW) for Wales. 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 performance indicators 4-6 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 risk group to determine adjusted treatment outcomes. Disease stage at diagnosis was adjusted for, instead of disease risk group, for performance indicator 4 (emergency readmissions) for England as disease risk group couldn’t be calculated using the RCRD due to the absence of Gleason score.

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 risk group 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)