Comparison of the treatment of men with prostate cancer between the US and England: an international population-based study

Abstract

Introduction:The treatment of prostate cancer varies between the United States (US) and England, however this has not been well characterised using recent data. We therefore investigated the extent of the differences between US and English patients with respect to initial treatment.Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database to identify men diagnosed with prostate cancer in the US and the treatments they received.We also used the National Prostate Cancer Audit (NPCA) database for the same purposes among men diagnosed with prostate cancer in England. Next, we used multivariable regression to estimate the adjusted risk ratio (aRR) of receiving radical local treatment for men with non-metastatic prostate cancer according to the country of diagnosis (US vs.England). The five-tiered Cambridge Prognostic Group (CPG) classification was included as an interaction term.Results: We identified 109,697 patients from the SEER database, and 74,393 patients from the NPCA database, who were newly diagnosed with non-metastatic prostate cancer between April 1 st 2014 and December 31 st 2016 with sufficient information for risk stratification according to the CPG classification. Men in the US were more likely to receive radical local treatment across all prognostic groups compared to men in England (% radical treatment US vs.

Urinary and Sexual Impact of Robotic Radical Prostatectomy: Reporting of Patient-reported Outcome Measures in the First Year after Radical Prostatectomy in a Contemporary Multicentre Cohort in the United Kingdom

“…We know that prostate cancer risk categorisation can impact functional outcomes, as it can influence decisions such as the degree of nerve sparing. In the NPCA cohort, 8.9% of men had Gleason 6 disease [6] , compared to 7.8% of men in TrueNTH. However, if low risk is defined according to D’Amico risk groups (Gleason score 6, prostate-specific antigen <10 ng/ml, and clinical stage ≥T2a [confined to less than half of one lobe]), 4.2% of men in TrueNTH and 0.7% of men in the NPCA analysis would meet these criteria, which could account for the slightly higher functional scores in TrueNTH Post Surgery.…”

A low prostate specific antigen predicts a worse outcome in high but not in low/intermediate-grade prostate cancer

“…Multi-modal treatment is not currently practised routinely in RP patients treated in the England, whereas multi-modal therapy is a standard of care for those treated with EBRT. Currently, treatment of high-risk PCa differs between regions as demonstrated in a recent comparison of the Surveillance, Epidemiology and End Results program and NPCA data showing that RP were more frequently used in the United States whereas in England EBRT is more commonly applied [25]. Thus, the data in this sense are paradoxical and unexplained.…”

Shifting the paradigm in the management of early prostate cancer

“…A mindset which views AS as a “waiting” option for men who will be eventually treated is different from one which views AS as the primary management option itself. Given these factors it is not surprising that there remain huge variations in over-treatment rates and AS conversion rates which have been shown time and time again in many health care systems [ 7 , 8 ].…”