title: Organisation of Prostate Cancer Services in the English National Health Service.
abstract: The National Prostate Cancer Audit (NPCA) started in April 2013 with the aim of assessing the process of care and its outcomes in men diagnosed with prostate cancer in England and Wales. One of the key aims of the audit was to assess the configuration and availability of specialist prostate cancer services in England.
  
  
  
  In 2014, the NPCA undertook an organisational survey of all 143 acute National Health Service (NHS) Trusts and 48 specialist multidisciplinary team (MDT) hubs cross England. Questionnaires established the availability and location of core diagnostic, treatment and patient-centred support services for the management of non-metastatic prostate cancer in addition to specific diagnostic and treatment procedures that reflect the continuing evolution of prostate cancer management, such as high-intensity focused ultrasound (HIFU) and stereotactic body radiotherapy.
  
  
  
  The survey received a 100% response rate. The results showed considerable geographical variation with respect to the availability of core treatment modalities, the size of the target population and catchment areas served by specialist MDT hubs, as well as in the uptake of additional procedures and services. Specifically there are gaps in the availability of core radiotherapy procedures; high dose rate and low dose rate brachytherapy are available in 44% and 75% of specialist MDTs, respectively. By comparison, there seems to be a relative 'over-penetration' of surgical innovation, with 67% of specialist MDTs providing robotic-assisted laparoscopic prostatectomy and 21% HIFU. There is also evidence of increased centralisation of core surgical procedures and regional inequity in the availability of surgical innovation across England.
  
  
  
  The organisational survey of the NPCA has provided a comprehensive assessment of the structure and function of specialist MDTs in England and the availability of prostate cancer procedures and services. As part of the prospective audit, the NPCA will assess the effect of the availability of prostate cancer services on access regionally and subsequent outcomes of care according to evidence-based guidelines.
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK. Electronic address: ajay.aggarwal@lshtm.ac.uk.
authors.forename: A
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Nossiter
authors.affiliation: National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK; Centre for Experimental Cancer Medicine, Bart's Cancer Institute, Queen Mary University of London, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Cathcart
authors.affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: van der Meulen
authors.affiliation: National Cancer Registration Service, Public Health England, UK.
authors.forename: J
authors.initials: J
authors.lastname: Rashbass
authors.affiliation: Christie and Salford Royal NHS Foundation Trusts, Manchester, UK.
authors.forename: N
authors.initials: N
authors.lastname: Clarke
authors.affiliation: University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Payne
mesh_terms: D004739:England; D006801:Humans; D008297:Male; D008485:Medical Audit; D009313:National Health Programs / Q000458:organization & administration*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000628:therapy*; D011795:Surveys and Questionnaires; D014852:Wales
keywords: Centralisation; clinical audit; geographical inequality; health services; prostate cancer