A retrospective analysis of Victorian and South Australian clinical registries for prostate cancer: trends in clinical presentation and management of the disease

Abstract

BackgroundProstate cancer (PCa) is the most commonly diagnosed malignancy reported to Australian cancer registries with numerous studies from individual registries summarizing diagnostic and treatment characteristics. The aim of this study was to describe annual trends in clinical and treatment characteristics, and changes in surveillance practice within a large combined cohort of men with PCa in South Australia (SA) and Victoria, Australia in 2008–2013.MethodsCommon data items from clinical registries in SA and Victoria were merged to develop a cross-jurisdictional dataset consisting of 13,598 men with PCa. Frequencies were used to describe these variables using the National Comprehensive Cancer Network risk of disease progression categories in 10 year age groups. A logistic regression analysis was performed to assess the impact of a number of factors (both individually and together) on the likelihood of men receiving no active treatment within twelve months of the diagnosis (i.e. managed with active surveillance/watchful waiting).ResultsTrend analysis showed that over time: (1) men in SA and Victoria are being diagnosed at older age in 2013, 66.1 (SD = 9.7) years compared to 2009 (64.5 (SD = 9.7)); (2) diagnostic methods and characteristics have changed with time; and (3) types of the treatments have changed, with more men having no active treatment. The majority of men were diagnosed with Prostate-Specific Antigen (PSA) <10 ng/mL (66 %) and Grade Group < 4 (65 %). Nearly seventy percent received radical treatment within 12 months of diagnosis, while ~20 % had no active treatment. In 14 % of cases treatment was not recorded or had not commenced. Having no active treatment was strongly associated older age, lower PSA and lower Grade Group at diagnosis, and in 2013 it was offered more frequently (more than 3 times) than in 2009 (OR = 2.63, 95 % CI: 2.16–3.22).ConclusionsFindings of this study provide the first cross-jurisdictional description of PCa characteristics and management in Australia. These findings will provide benchmarking for ongoing monitoring and feedback of disease management and outcomes of PCa through the Prostate Cancer Outcomes Registry–Australia New Zealand to improve evidence-based practice.

Declining use of radical prostatectomy and pelvic lymphadenectomy despite more robotics: National population data over 15 years

“…Along with a trend towards older age at diagnosis, many factors may have contributed to an upward grade and stage “migration” described internationally and in Australia and shift toward RP in the elderly (Figure ). Furthermore, the introduction of the minimally invasive RALP technique was shown to decrease peri‐operative complications compared to open surgery in a randomized controlled trial .…”

“…Men's acceptance of different risks and complications of treatment also influences choice of management . Radical prostatectomy (RP) with or without pelvic lymph node dissection (PLND) or radiotherapy [including neoadjuvant androgen deprivation therapy (ADT)] are most commonly used for intermediate and high‐risk localized PCa …”

“…Active surveillance (AS) of low‐risk PCa has been widely adopted to reduce overtreatment of indolent PCa and is selectively used for those subsequently diagnosed with clinically significant PCa, including low volume intermediate risk disease . Watchful waiting, as a similar approach has reduced active treatment in older men . where competing medical comorbidities will influence PCa‐specific mortality.…”

“…Limited descriptions of patterns of PCa care in Australia have been described to date . Detailed considerations of surgical patterns of care, specifically relating to age groups treated, geographic locations of treatment and use of PLND, as well as the uptake of robotic‐assisted laparoscopic prostatectomy (RALP), are yet to be described.…”

A systematic review of the unmet supportive care needs of men on active surveillance for prostate cancer

“…Prostate cancer (PCa) is one of the most prevalent cancers in men worldwide. The majority of men diagnosed with PCa are classified as having localised, low‐to‐intermediate risk disease, and receive active treatment immediately upon diagnosis. Active treatments for low‐risk PCa include radical prostatectomy and radiation, which often cause significant and ongoing side effects (including erectile, urinary, and rectal dysfunction) that can reduce quality of life.…”