NPCA Annual Report 2015

Published in November 2015, the results in this report cover the work undertaken since the launch of the prospective audit 1 April 2014.

More men with locally advanced prostate cancer are receiving curative treatments.

NPCA Annual Report 2015

The second Annual Report of the National Prostate Cancer Audit (NPCA) has been published today. The audit looks at whether NHS services in England and Wales for men diagnosed with prostate cancer meet recommended standards.
Prostate cancer is the most frequently diagnosed cancer in men and the third most common cause of cancer-related mortality in the United Kingdom, with about 40,000 new cases each year resulting in 10,000 deaths.
In its second year, the NPCA investigated how men diagnosed with prostate cancer between 2010 and 2013 in England were treated.

The audit found that men with locally advanced prostate cancer are increasingly being offered radical treatments in line with national guidelines. Locally advanced prostate cancer is cancer that is starting to break out of the prostate, or has spread to areas just outside the prostate and may also affect lymph nodes in the pelvis. The percentage of men with this stage of prostate cancer who had radical treatment went up from 27% between 2006 and 2008 to 47% between 2010 and 2013. These radical treatments aim to get rid of the prostate cancer tissue and cure the cancer.

The most frequently used radical treatment options for this group are external beam radiotherapy or surgical removal of the entire prostate (prostatectomy). Patients with locally advanced disease who are not having a radical treatment will be treated only with hormone therapy which does not cure the cancer but usually keeps it under control for several years.

Another important finding, also in line with national guidelines, was that the use of radical treatment in patients with low-risk prostate cancer is going down. Low-risk prostate cancer is cancer that is just in the prostate gland and not very likely to spread. The percentage of men with this stage of cancer who had radical treatment decreased from 28% between 2006 and 2008 to 13% between 2010 and 2013.

Dr Heather Payne, NPCA Oncological Clinical Lead, representing British Uro-oncology Group, said:

“The National Prostate Cancer Audit demonstrates that treatment for men with locally advanced prostate cancer is rapidly falling in line with national guidance. More and more men who are diagnosed with prostate cancer that has spread just outside the prostate are offered treatments that aim to fully cure their cancer.
This is very welcome as we know that about a third of men who are diagnosed with prostate cancer have locally advanced disease. A lot of them will benefit from radical treatments as they offer a chance to cure their cancer.”

Professor Noel Clarke, NPCA Urological Clinical Lead, representing British Association of Urological Surgeons, said:

“It is very encouraging to see a reduction in the use of radical treatments in men with low-risk prostate cancer. Men with this type of cancer have a very good prognosis with active surveillance which means that we carefully keep an eye on the cancer and only start treatment if the cancer is getting worse. In this way, we can avoid the serious side effects of radical prostate cancer treatments, including urinary incontinence, impotence and bowel problems.

It is also promising that for men with locally advanced prostate cancer surgery is being considered as an option, although the true benefit of surgery needs further validation in well-constructed clinical trials.”

Dr Jem Rashbass, National Director for Disease Registration Public Health England and NPCA Project Team member, said:

“The National Prostate Cancer Audit is the first national cancer audit to use the National Cancer Registration System to collect data. This system uses data collected directly from clinical teams as they treat patients. It sets a new benchmark for cancer audits in England.”

Professor Jan van der Meulen, NPCA Methodological Lead, said:

“For the National Prostate Cancer Audit, we use as much as possible existing electronic data. In this way, we are able to look in great detail at the care that is currently provided to men with prostate cancer in the NHS while keeping the burden on hospital staff involved in collecting data to a minimum.”

In April 2014, the audit started collecting detailed clinical information about the care that is provided to each man diagnosed with prostate cancer in England and Wales. This will produce a detailed database that will help NHS hospitals to evaluate their services. The NPCA will continue for a minimum of five years.

The NPCA is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme in response to the need for better information about the quality of prostate cancer services in England and Wales.

The audit is based in the Clinical Effectiveness Unit (CEU) at the Royal College of Surgeons of England (RCS) and is led by clinical experts from the British Association of Urological Surgeons (BAUS)and the British Uro-Oncology Group (BUG). The National Cancer Registration Service (NCRS) manages the data collection in England and Public Health Wales does the same in Wales.