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Objectives: To investigate whether patient‐reported urinary incontinence (UI) and bother scores after radical prostatectomy (RP) result in subsequent intervention with UI surgery. Patients and Methods: Men diagnosed with prostate cancer in the English National Health Service between April 2014 and January 2016 were identified. Administrative data were used to identify men who had undergone a RP and those who subsequently underwent a UI procedure. The National Prostate Cancer Audit database was used to identify men who had also completed a post‐treatment survey. These surveys included the Expanded Prostate Cancer Composite Index (EPIC‐26). The frequency of subsequent UI procedures, within 6 months of the survey, was explored according to EPIC‐26 UI scores. The relationship between 'good' (≥75) or 'bad' (≤25) EPIC‐26 UI scores and perceptions of urinary bother was also explored (responses ranging from 'no problem' to 'big problem' with respect to their urinary function). Results: We identified 11 290 men who had undergone a RP. The 3‐year cumulative incidence of UI surgery was 2.5%. After exclusions, we identified 5165 men who had also completed a post‐treatment survey after a median time of 19 months (response rate 74%). A total of 481 men (9.3%) reported a 'bad' UI score and 207 men (4.0%) also reported that they had a big problem with their urinary function. In all, 47 men went on to have UI surgery within 6 months of survey completion (0.9%), of whom 93.6% had a bad UI score. Of the 71 men with the worst UI score (zero), only 11 men (15.5%) subsequently had UI surgery. Conclusion: In England, there is a significant number of men living with severe, bothersome UI after RP, and an unmet clinical need for UI surgery. The systematic collection of patient‐reported outcomes could be used to identify men who may benefit from UI surgery. [ABSTRACT FROM AUTHOR]

This document is a reply to a letter to the editor regarding a previous article on prostate cancer outcomes following whole-gland and focal high-intensity focused ultrasound (HIFU). The authors of the reply acknowledge the comments and provide additional information about their study. They explain that their study used data collected from hospitals in England to provide real-world information about prostate cancer outcomes in men who received HIFU as their primary treatment. They note that their study did not include individual clinical information about diagnostic tests or the specific reasons for salvage treatment, but they hope that future trials will provide more detailed clinical information. The authors of the reply include a list of their disclosures and affiliations. [Extracted from the article]

Objectives The objective of this study is to explore how the UK versus the USA compare in patient characteristics, treatment patterns and overall survival (OS) of patients with advanced non-small cell lung cancer (aNSCLC) initiating first-line (1L) treatment.Design Retrospective cohort study.Setting Oncology treatment centres in the USA and UK.Participants People in the USA and UK diagnosed with aNSCLC and treated in the 1L setting between 2016 and 2018. The US cohort was obtained from a nationwide electronic health record-derived deidentified database. The UK cohort information was derived from a published study exploring the patient characteristics, treatments and outcomes of people with aNSCLC in the UK.Interventions 1L chemotherapy, immunotherapy monotherapy or targeted therapy.Primary outcome measure The primary outcome was OS—defined as the time from treatment initiation to death from any cause.Results There were 1003 patients in the UK and 3819 in the US cohorts receiving 1L therapy for aNSCLC. After standardising the US cohort to the UK cohort, median OS in the USA and UK was similar across 1L drug classes: chemotherapies (7.7 (95% CI 7.1 to 8.3) vs 8.1 (95% CI 7.4 to 8.9) months), immunotherapies (13.9 (95% CI 11.0 to 17.1) vs 14.0 (95% CI 10.7 to 20.6)) and targeted therapies (21.6 (95% CI 18.5 to 23.7) vs 20.2 (95% CI 16.0 to 30.5)). OS curves for 1L immunotherapy and targeted therapy were almost overlapping after standardisation. OS after around 12 months was higher in US patients compared with UK patients receiving 1L chemotherapy regimens. Of those receiving 1L chemotherapy, the proportion receiving any second-line therapy appeared higher for patients in the USA versus UK.Conclusions The results suggest that in aNSCLC patients receiving 1L treatment, US data have the potential to be used in technology evaluations to understand long-term OS where UK data are unavailable or sparse.

Objectives Examine whether data from early access to medicines in the USA can be used to inform National Institute for Health and Care Excellence (NICE) health technology assessments (HTA) in oncology.Design Retrospective cohort study.Setting Oncology-based community and academic treatment centres in the USA.Participants Patients present in a nationwide electronic health record (EHR)-derived deidentified database.Interventions Cancer drugs that underwent NICE technology appraisal (TA) between 2014 and 2019.Primary and secondary outcome measures The count and follow-up time of US patients, available in the EHR, who were exposed to cancer drugs of interest in the period between Food and Drug Administration (FDA) approval and dates relevant to the NICE appraisal process.Results In 59 of 60 TAs analysed, the cancer therapy was approved in the USA before the final appraisal by NICE. The median time from FDA approval to the publication of NICE recommendations was 18.5 months, at which time the US EHR-derived database had, on average, 269 patients (SD=356) exposed to the new therapy, with a median of 75.3 person-years (IQR: 13.1–173) in time-at-risk. A case study generated evidence on real-world overall survival and treatment duration.Conclusions Across different cancer therapies, there was substantial variability in US real-world data accumulated between FDA approval and NICE decision milestones. The applicability of these data to generate evidence for HTA decision-making should be assessed on a case-by-case basis depending on the intended HTA use case.

Objectives As part of the PIONEER Consortium objectives, we have explored which diagnostic and prognostic factors (DPFs) are available in relation to our previously defined clinician and patient-reported outcomes for prostate cancer (PCa).Design We performed a systematic review to identify validated and non-validated studies.Data sources MEDLINE, Embase and the Cochrane Library were searched on 21 January 2020.Eligibility criteria Only quantitative studies were included. Single studies with fewer than 50 participants, published before 2014 and looking at outcomes which are not prioritised in the PIONEER core outcome set were excluded.Data extraction and synthesis After initial screening, we extracted data following the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of prognostic factor studies (CHARMS-PF) criteria and discussed the identified factors with a multidisciplinary expert group. The quality of the included papers was scored for applicability and risk of bias using validated tools such as PROBAST, Quality in Prognostic Studies and Quality Assessment of Diagnostic Accuracy Studies 2.Results The search identified 6604 studies, from which 489 DPFs were included. Sixty-four of those were internally or externally validated. However, only three studies on diagnostic and seven studies on prognostic factors had a low risk of bias and a low risk concerning applicability.Conclusion Most of the DPFs identified require additional evaluation and validation in properly designed studies before they can be recommended for use in clinical practice. The PIONEER online search tool for DPFs for PCa will enable researchers to understand the quality of the current research and help them design future studies.Ethics and dissemination There are no ethical implications.

Background: Improvements in short-term outcomes have been reported for hospitals with higher radical prostatectomy (RP) volumes. However, the association with longer-term functional outcomes is unknown., Methods: All patients diagnosed with non-metastatic prostate cancer in the English NHS between 2014 and 2016 who underwent RP (N = 10,089) were mailed a survey ≥18 months after diagnosis. Differences in patient-reported urinary continence and sexual function (EPIC-26 on scale from 0 to 100) by hospital volume group (≤60, 61-100, 101-140, >140 RPs/year) were estimated using multilevel linear regression., Results: Overall, 7702 men (76.3%) responded. There were no statistically significant differences in urinary continence (p = 0.08) or sexual function scores with increasing volume group (p = 0.2). When modelled as a linear function, we found a non-significant increase of 0.70 (95% CI -0.41 to 1.80; p = 0.22) in urinary continence and a significant increase of 1.54 (0.62-2.45; p = 0.001) in sexual function scores for a 100-procedure increase in hospital volume, which did not meet the threshold for a minimal clinically important difference (10-12 points). The results were similar for robotic-assisted RP (5529 men [71.8%])., Conclusions: These results do not support further centralisation of RP services beyond levels in England where four in five hospitals perform >60 RPs/year., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Many factors are implicated in the potential 'under-treatment' of prostate cancer but little is known about the between-hospital variation., Methods: The National Prostate Cancer Audit (NPCA) database was used to identify high-risk localised or locally advanced prostate cancer patients in England, between January 2014 and December 2017, and the treatments received. Hospital-level variation in radical local treatment was explored visually using funnel plots. The intra-class correlation coefficient (ICC) quantified the between-hospital variation in a random-intercept multivariable logistic regression model., Results: 53,888 men, from 128 hospitals, were included and 35,034 (65.0%) received radical local treatment. The likelihood of receiving radical local treatment was increased in men who were younger (the strongest predictor), more affluent, those with fewer comorbidities, and in those with a non-Black ethnic background. There was more between-hospital variation (P < 0.001) for patients aged ≥80 years (ICC: 0.235) compared to patients aged 75-79 years (ICC: 0.070), 70-74 years (ICC: 0.041), and <70 years (ICC: 0.048). Comorbidity and socioeconomic deprivation did not influence the between-hospital variation., Conclusions: Radical local treatment of high-risk localised or locally advanced prostate cancer depended strongly on age and comorbidity, but also on socioeconomic deprivation and ethnicity, with the between-hospital variation being highest in older patients., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)