Variation in usage of radical prostatectomy and radical radiotherapy for men with locally advanced prostate cancer

Locally advanced prostate cancer is defined as primary tumours extending outside the prostate gland to the surrounding tissues or seminal vesicles but without spread beyond the pelvic region. With radical treatment there is good prospect of cure. Radiotherapy in combination with hormone therapy is well established, but specific NICE guidelines have only recently been published. The guidelines recommend offering either radical prostatectomy (RP), possibly with adjuvant radiotherapy, or radical radiotherapy (RT) with neo-adjuvant hormone therapy as treatment for men with locally advanced prostate cancer. Given that guidelines on managing locally advanced prostate cancer have recently changed, we wanted to quantify the baseline variation in use of radical treatments for this patient group. Methods: Men with T3/T4 N0 M0 prostate cancer who were diagnosed in 2010–2012 were identified using data from the National Cancer Registration and Analysis Service (NCRAS). Data on age, ethnicity, deprivation, Charlson comorbidity score, Strategic Clinical Network (SCN) of residence, and treatments delivered were extracted. A multivariable logistic regression was undertaken to identify important variables. Results: Overall, 1692 (14%) of men in the cohort had a record of radical prostatectomy. A total of 6212 (52%) had a record of curative RT. In a regression model each decade increase in age yielded odds of 0.39 ( p < 0.001) for receiving radical treatment. Black men were only half as likely as white men to receive radical treatment (OR = 0.54; p < 0.001). Deprivation, comorbidity and SCN of residence had smaller effects. The variation observed in radical treatment between SCNs largely disappeared once the multiple variables were accounted for. Conclusion: Radical treatments vary by 71% to 85% between networks for men aged 60–69 years. Given that men >80 years made up 12% of the study population and only 6% had a Charlson comorbidity score >0, there is a possibility that some men with ‘clinically significant’ disease are undertreated.