Overall, the age-standardised incidence rate, standardised to the European standard population for all ages, was 93.5 per 100
000 population, and this increased from 83.1 per 100
000 in 2000 to 96.6 per 100
000 in 2004 (). There were a total of 21
334 cases in our study population after exclusions and the number of these cases diagnosed each year increased from 2572 in 2000 to 3264 in 2006.
Table 1 European age-standardised rates (ASR) per 100000 male population and 95% confidence intervals (CI) by year for all ages
shows the overall percentage of men receiving each treatment. shows the demographic characteristics of the study population by treatment group and shows the principal treatment by year of diagnosis.
Number and percentage of men receiving each treatment
Demographic characteristics of the study population by treatment group
Principal treatment by year of diagnosis.
Overall, between 2000 and 2006, hormone therapy was the most common mode of treatment (42%), whereas 29% of patients received no treatment and 11% of patients received a radical prostatectomy. The rate of radical prostatectomy increased from 7% in 2000 to 13% in 2006. The brachytherapy rate remained at approximately 2% over the 7-year period and the external beam radiotherapy rate increased slightly over time from 14% in 2000 to 18% in 2006. The use of hormone therapy decreased over time from 48% in 2000 to 32% in 2006. The percentage of patients receiving no treatment remained between 27 and 29% from 2000 to 2005 but increased to 35% in 2006.
There were higher percentages of men aged 55–64 and 65–74 years who received all three radical treatments when compared with men aged
75 years; for men aged
75 years, 3% received a radical prostatectomy, 1% received brachytherapy and 8% received hormone therapy. Lower percentages of men aged 55–64 years received hormone therapy (8%) and no treatment (14%) when compared with men aged
There were statistically significant differences in the treatments received by network of residence. Radical prostatectomies were more common in YCN (14%) than in HYC (8%) and in NECN (9%). Brachytherapy was also more common in YCN (3%) than the other two networks. External beam radiotherapy was more common in YCN (18%) and in HYC (22%) than in NECN (12%). Only 35% of patients in YCN were treated by hormone therapy compared with 43% of patients in HYC and 48% in NECN. Fewer men in HYC (25%) received no treatment when compared with YCN (29%) and NECN (31%).
The treatment received also varied by deprivation quintile. There was a linear trend in the percentage of men who received a radical prostatectomy: 13% of men in the most affluent areas received this treatment when compared with only 8% of men in the most deprived areas. A similar socio-economic gradient was also observed for brachytherapy and external beam radiotherapy: rates were highest in the most affluent areas and lowest in the most deprived areas. Only 35% of men in the most affluent areas received hormone therapy compared with 48% of men in the most deprived areas. There was not much difference in the percentage of men who received no treatment by deprivation quintile. also shows the principal treatment received by deprivation quintile.
Principal treatment by deprivation quintile.
shows the results from the multivariate logistic regression models.
Association between treatment received and demographic variables, odds ratios (OR) and 95% confidence intervals (CI). Results from multivariate logistic regression
Men diagnosed with prostate cancer in 2006 were 53% more likely to receive a radical prostatectomy than men diagnosed in 2000 (odds ratio (OR)=1.53, 95% confidence interval (CI) 1.26–1.86). There were no statistically significant differences in the likelihood of receiving brachytherapy or external beam radiotherapy over time. Men diagnosed in 2006 were 43% less likely to have hormone treatment than men diagnosed in 2000 (OR=0.57, 95% CI 0.51–0.64). The odds of having no treatment were 42% higher in 2006 when compared with 2000 (OR=1.42, 95% CI 1.27–1.59).
There was a very strong association between age and treatment received. The odds of having a radical prostatectomy, brachytherapy or external beam radiotherapy decreased as age at diagnosis increased. The OR for men aged
75 years, compared with men aged 55–64 years, for receiving a radical prostatectomy were 0.02 (95% CI 0.01–0.02), for receiving a brachytherapy were 0.01 (95% CI 0.004–0.03) and for receiving an external beam radiotherapy were 0.08 (95% CI 0.07–0.10). The odds of receiving hormone therapy, and no treatment significantly increased as age at diagnosis increased. The OR for men aged
75 years, compared with men aged 55–64 years, for receiving hormone therapy were 7.67 (95% CI 7.00–8.41) and for receiving no treatment were 2.15 (95% CI 1.98–2.35).
For all treatment modalities there were statistically significant differences across the networks. Compared with YCN, radical prostatectomy and brachytherapy were less likely in HYC (OR=0.54, 95% CI 0.47–0.63 and OR=0.54, 95% CI 0.40–0.71) and in NECN (OR=0.64, 95% CI 0.58–0.71 and OR=0.36, 95% CI 0.28–0.45). External beam radiotherapy was more likely in HYC (OR=1.35, 95% CI 1.22–1.50) and less likely in NECN (OR=0.58, 95% CI 0.53–0.63) compared with YCN. The odds of receiving hormone therapy were more likely in both HYC and NECN compared with YCN (OR=1.36, 95% CI 1.25–1.49 and OR=1.64, 95% CI 1.53–1.75). The odd of receiving no treatment were significantly lower in HYC than in YCN (OR=0.81, 95% CI 0.74–0.88) and significantly higher in NECN than in YCN (OR=1.09, 95% CI 1.02–1.17).
The odds of receiving a radical prostatectomy, brachytherapy or external beam radiotherapy were all significantly lower in the most deprived areas compared with the most affluent (OR=0.64, 95% CI 0.55–0.75; OR=0.32, 95% CI 0.22–0.47; and OR=0.83, 95% CI 0.74–0.94, respectively). The odds of receiving hormone therapy increased as deprivation increased (OR=1.56, 95%CI 1.42–1.71) for most deprived areas compared with most affluent areas. The association between deprivation and receiving no treatment was of borderline statistical significance (P=0.05); the magnitude of the effect was similar in all deprivation quintiles relative to the most affluent quintile but only statistically significantly different in quintiles 2 and 4 (OR=0.90, 95% CI 0.82–0.99 and OR=0.86, 95% CI 0.78–0.95 respectively).