Trends and outcome from radical therapy for primary non-metastatic prostate cancer in a UK population.
BACKGROUND
Increasing proportions of men diagnosed with prostate cancer in the UK are presenting with non-metastatic disease. We investigated how treatment trends in this demographic have changed.


METHODS
Non-metastatic cancers diagnosed from 2000-2010 in the UK Anglian Cancer network stratified by age and risk group were analysed [n = 10,365]. Radiotherapy [RT] and prostatectomy [RP] cancer specific survival [CSS] were further compared [n = 4755].


RESULTS
Over the decade we observed a fall in uptake of primary androgen deprivation therapy but a rise in conservative management [CM] and radical therapy [p<0.0001]. CM in particular has become the primary management for low-risk disease by the decade end [p<0.0001]. In high-risk disease however both RP and RT uptake increased significantly but in an age dependent manner [p<0.0001]. Principally, increased RP in younger men and increased RT in men ≥ 70y. In multivariate analysis of radically treated men both high-risk disease [HR 8.0 [2.9-22.2], p<0.0001] and use of RT [HR 1.9 [1.0-3.3], p = 0.024] were significant predictors of a poorer CSM. In age-stratified analysis however, the trend to benefit of RP over RT was seen only in younger men [≤ 60 years] with high-risk disease [p = 0.07]. The numbers needed to treat by RP instead of RT to save one cancer death was 19 for this group but 67 for the overall cohort.


CONCLUSIONS
This study has identified significant shifts in non-metastatic prostate cancer management over the last decade. Low-risk disease is now primarily managed by CM while high-risk disease is increasingly treated radically. Treatment of high-risk younger men by RP is supported by evidence of better CSM but this benefit is not evident in older men.
Public Health England, National Cancer Registration Service [Eastern Office], Cambridge, United Kingdom.
David C
DC
Greenberg
Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, United Kingdom; Institute of Population Health, University of Manchester, Manchester, United Kingdom.
Artitaya
A
Lophatananon
Public Health England, National Cancer Registration Service [Eastern Office], Cambridge, United Kingdom.
Karen A
KA
Wright
Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, United Kingdom; Institute of Population Health, University of Manchester, Manchester, United Kingdom.
Kenneth R
KR
Muir
Academic Urology Group, Department of Surgery & Oncology, University of Cambridge, Cambridge, United Kingdom; Translational Prostate Cancer Group, Hutchison/MRC Research centre, University of Cambridge, Cambridge, United Kingdom.
Vincent J
VJ
Gnanapragasam
D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D006113:United Kingdom