© 2009 THE AUTHORS 1226 JOURNAL COMPILATION © 2 0 0 9 B J U I N T E R N A T I O N A L | 1 0 5 , 1 2 2 6 – 1 2 3 0 | doi:10.1111/j.1464-410X.2009.08940.x 2009 THE AUTHORS. JOURNAL COMPILATION 2009 BJU INTERNATIONAL Urological Oncology PROSTATE CANCER INCIDENCE, STAGE, TREATMENT AND SURVIVAL IN UK ETHNIC GROUPS JACK et al. Prostate cancer incidence, stage at diagnosis, treatment and survival in ethnic groups in South-East England Ruth H. Jack, Elizabeth A. Davies and Henrik Møller King’s College London, Thames Cancer Registry, London, UK Accepted for publication 8 July 2009 and for narrower age groups, with White men as the baseline group. Logistic regression was used to assess whether patients had a stage of disease recorded at diagnosis, if so whether it was metastatic, and to examine treatment received. To assess overall and prostate cancer-specific survival (PCSS), Cox regression models were fitted, adjusting sequentially for age, socioeconomic status, treatment received and stage of disease at diagnosis. RESULTS Indian/Pakistani men had a lower age- standardized rate than White men (rate ratio 0.69, 95% confidence interval 0.63–0.75), while Black men had a higher rate ratio (2.51, 2.30–2.73). There was no difference in the proportion of men diagnosed with metastatic disease in each ethnic group. There was variation in recorded surgery and hormone treatment. Indian/Pakistani men had better PCSS than White men (fully adjusted hazard ratio 0.76, P = 0.024). There was no difference in PCSS between Black and White men (hazard ratio 0.93, P = 0.238). CONCLUSIONS Black men had the highest incidence of prostate cancer, followed by White, then Indian/Pakistani men. The relative excess of prostate cancer in Black vs White men was strongly age-dependent. Despite differences in recorded treatment, Indian/Pakistani men had better overall survival and PCSS. Black men also had better overall survival, and their PCSS was similar to that of White men. This might be due to access to the publicly funded National Health Service in the UK. KEYWORDS prostate cancer, epidemiology, incidence, stage, treatment, survival Study Type – Prevalence (prospective cohort) Level of Evidence 1b OBJECTIVES To use self-assigned ethnicity to examine patterns of incidence, stage, treatment and survival in patients with prostate cancer in South-east England. PATIENTS AND METHODS Data on 36 961 men resident in South-east England and diagnosed with prostate cancer between 1998 and 2003 were extracted from the Thames Cancer Registry. Ethnicity information was obtained from the Hospital Episode Statistics dataset, and matched to the cancer records. The ethnic groups examined were White (19 688), Black (1422) and Indian/Pakistani (397). Age-standardized incidence rate ratios were calculated overall INTRODUCTION International differences in the incidence of prostate cancer are well established, with the highest rates found in the USA and the lowest rates in India and China [1]. Data from the USA [2,3] and the UK [4–7] have shown that Black men have higher incidence rates than White men within the same country. Population-based studies in the UK have shown that South Asians have a lower incidence of prostate cancer than non-South Asians, after adjusting for age [8,9] or age and socioeconomic status (SES) [10]. While to date there has been little research on patterns of prostate cancer stage and treatment in different ethnic groups in the UK, this has been more common in the USA. There have been conflicting results about whether there are differences in stage distributions between ethnic groups [11–13]. Black men have been shown to be less likely to receive surgery than White men [11,14–17], while there is less variation for other treatments [11,17]. Studies in the USA have found no difference in overall survival (OS) between ethnic groups, while Black men have worse prostate cancer-specific survival (PCSS) [18,19] and there was no difference between USA South Asian and White groups [13]. In the present study we aimed to use self- assigned ethnicity information for the first time in a large population in South-east England to examine the incidence, stage of disease at diagnosis, treatment received and survival in patients with prostate cancer. PATIENTS AND METHODS In the UK, cancer registries record the occurrence of cancer in their resident populations. During the period studied, the Thames Cancer Registry (TCR) covered a population of ≈14 million people in South- east England. This area includes London, which is the most ethnically diverse area of the UK [20]. Registration is initiated by clinical and pathological information received from hospitals, and by information about deaths provided by the NHS Central Register through the Office for National Statistics. Trained data-collection officers then extract further information on demographic details, disease stage and treatment in the first 6 months after diagnosis from the medical records. Data are quality assured, as they are added to the BJUI BJU INTERNATIONAL