The National Prostate Cancer Audit that reported for the first time on 10 November 2014 reveals some alarming variations in the standards of care across England and Wales. The audit was commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Surgeons. It investigated the organisation and delivery of prostate cancer services from diagnosis, staging of the disease and the therapies provided to the impact on patients and an assessment of care against NHS standards.
Prostate cancer affects around 40,000 men each year of whom 10,000 die from the disease. While significant advances have been made in recent years in detecting and treating the disease and improving public awareness, the findings highlight wide divergence between different hospitals in the diagnostic and therapeutic services available.
There are 143 NHS Trusts in England and 10 in Wales that provide prostate cancer services. Over a quarter of these cannot offer advanced MRI techniques recommended for detecting and localising prostate cancer in certain patients.
Treatment of the disease is even more diverse. Surgery for prostate cancer is centralised to 61 NHS Trusts in England and three in Wales but only 27 of these can offer robot-assisted laparoscopic prostatectomy. Using a robot dramatically reduces damage to surrounding tissues during surgical removal of the cancer compared with other techniques.
Radiotherapy treatment is also centralised to 57 NHS Trusts. Intensity modulated radiotherapy is widely regarded as the benchmark for prostate cancer care but nearly 10% of NHS Trusts cannot offer this. Advanced high-dose brachytherapy treatment, which is used to treat intermediate or high-risk localised and late stage cancer, is only offered by one in five English centres and it is not available at all in Wales.
Support services are also poor and patchy, with only half of hospitals in England offering the full range of services needed by prostate cancer patients. These range from advice on continence and sexual function to psychological counselling and support.
The audit concludes that advanced diagnostic MRI and high-dose brachytherapy for advanced patients, which is only available in one in five centres in England, must be more widely available.
Responding to the report, Andrew Clayton in the clinical negligence team at Penningtons Manches explains: "There have been major recent advances in detecting and treating prostate cancer but this audit sadly highlights that too many men are unable to access the services they need. The statistics on survival rates speak for themselves. All patients must be offered the latest treatment to have the best chance of survival. However, in our practice we see huge variations in the speed with which potential indicators are investigated and acted upon and in the available treatment options.
"We know from clients that a diagnosis of prostate cancer has a huge emotional and psychological impact which is not limited to the diagnosis and immediate treatment. For patients whose disease is successfully treated there can be profound, life-long effects and they need continuing support. It is unacceptable that this support is only available to half the patients. We hope this audit will lead to improved clinical management and better outcomes for patients."