An audit of the investigation and treatment of localised prostatic cancer in the south west region.

Prostate cancer constitutes a major health care dilemma in terms of treatment options available and increasing patient load on both a regional and national level. An audit was undertaken of all patients in the South West Region with localised prostate cancer newly diagnosed in 1993 to assess regional management of this disease. In 1993, 1407 patients were newly diagnosed as having prostatic cancer. Patients > 75 years old and those with a prostate-specific antigen (PSA) > 40 ng/ml were excluded, leaving 262 patients whose case notes were examined. The interval between referral and clinic (mean 67 days) was altered by the presence of a GP performed PSA, being shorter if the PSA was > 10 ng/ml (average 54 days) than if the PSA was < 10 ng/ml (average 104 days). Overall, 34% of patients underwent radical treatment (10% radical prostatectomy and 24% radiotherapy). In all, 27% received hormone manipulation or orchidectomy, and the remainder 'watchful waiting'. The majority (78%) of patients < 60 years old received radical treatment, as did 35% of those 60-70 years and 15% of 70-75 year olds. Over 90% of tumours were category T1 and were well or moderately differentiated. All patients had a histological diagnosis and 84% had their tumour staged before treatment. This study highlighted the need for improvements in patient assessment, improved note keeping and a regional cancer register to allow ongoing assessment of patient management. This audit of management of localised prostate cancer serves as a baseline from which to initiate and monitor improvements in the service regionally and will also allow assessment of the impact of such changes.