Impact of centralisation of prostate cancer services on the choice of radical treatment

Abstract

Objective: To assess the impact of centralisation of prostate cancer surgery and radiotherapy services on the choice of prostate cancer treatment. Patients and methods: This national population-based study used linked cancer registry data and administrative hospital-level data for all 16,621 men who were diagnosed between 1st Jan 2017 and 31st Dec 2018 with intermediate risk prostate cancer and underwent a radical prostatectomy (RP) or radical radiation therapy (RT) in the English National Health Service. Travel times by car to treating centres were estimated using a Geographic Information System. We used logistic regression to assess the impact of the relative proximity of alternative treatment options on the type of treatment received with adjustment for patient characteristics. Results: Of the 78 NHS hospitals that provide RT or RP for prostate cancer, 41% provide both, 36% provide RT and 23% provide RP. Compared to men who had both treatment options available at their nearest centre (57% received RT, 43% RP), men were less likely to receive RT if their nearest centre offered RP only and the extra travel time to a hospital providing RT was >15 minutes (RT 52%/RP 48%, OR 0.70 (0.58-0.85), p<0.001). Conversely, men were more likely to receive RT if their nearest centre offered RT and the extra travel time to a hospital providing RP was >15 minutes (RT 63%/RP 37%, OR 1.23 (1.08-1.40) p<0.001). There was a negligible impact on the type of treatment received if centres providing alternative treatment options were ≤15 minutes travel time from each other. Conclusion: The relative proximity of prostate cancer treatment options to a patient's residence is an independent predictor for the type of radical treatment received. Centralisation policies for prostate cancer should not focus on one treatment modality but consider all treatments to avoid a negative impact on treatment choice.