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

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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 1st 2014 and December 31st 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. England, CPG1: 38.1% vs. 14.3% – aRR 2.57, 95% CI 2.47–2.68; CPG2: 68.6% vs. 52.6% – aRR 1.27, 95% CI 1.25–1.29; CPG3: 76.7% vs. 67.1% – aRR 1.12, 95% CI 1.10–1.13; CPG4: 82.6% vs. 72.4% – aRR 1.09, 95% CI 1.08–1.10; CPG5: 78.2% vs. 71.7% – aRR 1.06, 95% CI 1.04–1.07)

Conclusions

Treatment rates were higher in the US compared to England raising potential over-treatment concerns for low-risk disease (CPG1) in the US and under-treatment of clinically significant disease (CPG3-5) in England.

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Fig. 1: Management of men with prostate cancer between 2014 and 2016, stratified by country (England vs. US) and Cambridge Prognostic Group (CPG).

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Data availability

The cancer registry data used for this study are based on information collected and quality assured by Public Health England’s National Cancer Registration Service (www.ncras.nhs.uk). Access to the data was facilitated by the Public Health England’s Office for Data Release. Hospital Episode Statistics were made available by the NHS Digital (www.digital.nhs.uk); all rights reserved. MGP had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. Data are not available to other researchers as it uses existing national datasets.

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Acknowledgements

We thank NHS staff for their support in collecting the clinical data, the National Cancer Registration and Analysis Service (www.ncras.nhs.uk) for providing cancer registry and radiotherapy data and NHS Digital (www.digital.nhs.uk) for providing Hospital Episode Statistics. MGP, JN, MM, AS, BB, AN, PC, AA, JvdM, HP, and NWC are members of the Project Team of the National Prostate Cancer Audit (www.npca.org.uk). The National Prostate Cancer Audit is commissioned by the Healthcare Quality Improvement Partnership (www.hqip.org.uk) as part of the National Clinical Audit and Patient Outcomes Programme, and funded by NHS England and the Welsh Government. Neither HQIP nor NHS England or the Welsh Government had any involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The researchers had full independence from the Healthcare Quality Improvement Partnership. MGP was supported by a Doctoral Research Fellowship from the National Institute for Health Research (DRF-2018-11-ST2-036). TAS was supported by the National Cancer Institute (R01 CA242559 and R37 CA222885). BB and AN were partly supported by an Academic Clinical Fellowship from the National Institute for Health Research. HP was supported by the University College London Hospitals/University College London Comprehensive Biomedical Research Centre. JvdM was partly supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North Thames. The views expressed in this paper are solely those of the authors.

Author information

Authors and Affiliations

Authors

Contributions

Designed the work: MGP, JvdM, QT, HP, NWC. Analysed and interpreted data: MGP, JvdM, QT, HP, NWC. Drafted paper: MGP, JvdM, QT, HP, NWC. Provided critical revision: All authors. Approved final version to be published: All authors.

Corresponding author

Correspondence to Matthew G. Parry.

Ethics declarations

Competing interests

AS is an employee of Flatiron Health, an independent subsidiary of the Roche group, and holds stock in Roche. JvdM reports a contract with the Healthcare Quality Improvement Partnership for the provision of the National Prostate Cancer Audit (www.npca.org.uk) funded by the Healthcare Quality Improvement Partnership (www.hqip.org.uk). HP has attended and received honoraria for advisory boards, travel expenses to medical meetings, and served as a consultant for AstraZeneca, Astellas, Janssen, Sanofi Aventis, Takeda, Ipsen, Ferring, Sandoz, and Novartis. N.W.C. has attended and received honoraria for advisory boards, travel expenses to medical meetings, and served as a consultant for AstraZeneca, Astellas, Bayer, Janssen, Sanofi Aventis, Takeda, Ipsen and Ferring.

Ethics approval and consent to participate

This study was exempt from NHS Research Ethics Committee approval because it involved analysis of pseudonymised linked data collated for the purpose of service evaluation as part of the National Prostate Cancer Audit.

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Parry, M.G., Nossiter, J., Morris, M. et al. Comparison of the treatment of men with prostate cancer between the US and England: an international population-based study. Prostate Cancer Prostatic Dis 26, 287–292 (2023). https://doi.org/10.1038/s41391-021-00482-6

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