Improving Data Collection Quality and Completeness for Systemic Anti-Cancer Therapy (SACT) in Prostate Cancer

Prostate Cancer Data Crisis

Prostate cancer has become the most diagnosed cancer in the UK, with 64,425 cases in 2022 alone, a 24% jump from the prior year. This rise aligns with global projections from the 2024 Lancet Commission, forecasting nearly 2.9 million annual cases by 2040 due to aging populations and longer lifespans. In England, diagnoses increased 9% from 2023 to 2024, reaching 58,218. These trends demand robust data to guide resource allocation and policy.

The Systemic Anti-Cancer Therapy (SACT) dataset, managed by NHS Digital's National Disease Registration Service (NDRS), captures treatment details for all cancer patients in England. Its version 4.0, set for April 2026, expands to 60 items across seven sections, enhancing tracking of regimens, outcomes, and demographics. However, current challenges include incomplete submissions and variations in data quality, as noted in the 2025 National Prostate Cancer Audit (NPCA) State of the Nation Report. In Wales, a new informatics system transition has temporarily degraded data reliability.

Real-world impacts are stark: incomplete SACT data contributes to underuse of intensified treatments for metastatic hormone-sensitive prostate cancer (mHSPC), with only 39% of 29,713 patients from 2018-2022 receiving them. This varies by age, ethnicity, and region, with Black patients and those over 75 far less likely to benefit. Consequences include higher mortality rates; for instance, COVID-19 reduced diagnoses by thousands in 2020, leading to delayed treatments and poorer prognoses.

Stakes involve deadlines like the SACT upgrade, with non-compliance risking funding cuts or audit failures. Costs mount: a targeted screening program for high-risk groups could add £25 million annually to NHS budgets—0.01% of total—but prevent late-stage cases costing up to £50,000 each in advanced care. Inaction perpetuates disparities, with treatment intensification ranging from 20.3% to 53.7% across specialist multidisciplinary teams.

Non-obvious tensions arise in balancing privacy with data sharing for research, as seen in the PROSTATE PROGRESS platform aiming for centralized insights. AI-driven tools promise faster diagnostics but require high-quality data to avoid biases. The UK National Screening Committee's November 2025 rejection of broad PSA screening, opting only for BRCA carriers, contrasts with EU pushes, highlighting debates over overdiagnosis versus missed aggressive cancers. Ethnic disparities persist, with Black men facing higher risks but lower screening uptake, amid calls for guideline changes.