Initial management of low‐risk localized prostate cancer in the UK: analysis of the British Association of Urological Surgeons Cancer Registry

Abstract

Study Type – Therapy (outcomes research) Level of Evidence 2c OBJECTIVE To assess the patterns of care for low‐risk localized prostate cancer. Management of this condition is highly controversial, with a range of treatment options, but there are no published UK data. METHODS Data from the British Association of Urological Surgeons (BAUS) Cancer Registry were linked to the UK Association of Cancer registries postcode directory. The demographic and clinical characteristics, and the initial management of men diagnosed with low‐risk localized prostate cancer in the UK between 2000 and 2006 were analysed. RESULTS In all, 43 322 cases of localized prostate cancer were recorded in the BAUS Registry between 2000 and 2006, of which 8861 (20%) met the criteria for low‐risk disease. The proportion classified as low risk ranged from 16% in 2000 to 21% in 2006. The proportion of men with low‐risk disease opting for ‘watchful waiting’ increased from 0% to 39% over the same period. Treatment choice was associated with socio‐economic status. For example, radical prostatectomy was chosen by 34% of patients in the most affluent quintile, compared with 19% in the most deprived quintile (P= 0.01). CONCLUSION The management of low‐risk localized prostate cancer in the UK has changed markedly in recent years, and contrasts with that in the USA. The association observed between socio‐economic status and choice of treatment deserves further study.

Psychological and Social Factors influencing Patients’ Treatment Selection for Localised Prostate Cancer

“…Overall, patients believed surgery to be the best and most effective form of treatment. This corresponds with current treatment rates, which show that the majority of patients with LPCa opt for surgery [36].…”

Who Bears the Greatest Burden of Aggressive Treatment of Indolent Prostate Cancer?

“…Studies looking at low-risk deferred treatment trends in European populations were unable to report results by race due to relatively homogenous study cohorts. 10,28 Furthermore, an earlier SEER study did not report results by race. 11 Therefore, our findings that Caucasian men are more susceptible to aggressive treatment for indolent disease are novel and should guide future efforts that seek to reduce unnecessary aggressive treatment rates.…”

“…26,27 For example, studies from European populations have suggested that men of higher education level or from more affluent areas were more likely to seek aggressive treatment for prostate cancer-a behavior that may be driven by trust in providerdelivered therapies and willingness to receive treatment despite potential risks and side effects. 10,28 Schulman et al 29 found that patient race independently influences physician treatment recommendations, with physicians more likely to recommend aggressive therapy for white patients compared with black patients when presented with hypothetical cases of chest pain. Thus, it is possible that physicians may be more likely to recommend aggressive therapy for more affluent, Caucasian, or married patients with low-risk prostate cancer.…”

Is There a Role for Active Surveillance in Low-Risk Prostate Cancer?

“…In the UK, where PSA testing is less prevalent, 20% of patients with localized PCa met the criteria for low-risk disease according to the classification of D'Amico et al [20,34] . Hence, the rigor of inclusion criteria and the PSA testing rate distinctly affect the proportion of men eligible for AS.…”