Outcomes after radical prostatectomy and cystectomy are on average likely to be better if these procedures are performed by and at high volume providers. For radical nephrectomy the evidence is unclear. The impact of volume based policies (increasing volume to improve outcomes) depends on the extent to which "practice makes perfect" explains the observed results. Further studies should explicitly address selective referral and confounding as alternative explanations. Longitudinal studies should be performed to evaluate the impact of volume based policies.

Study Type – Therapy (outcomes research)
Level of Evidence 2c OBJECTIVE To assess the patterns of care for low‐risk localized prostate cancer. Management of this condition is highly controversial, with a range of treatment options, but there are no published UK data. METHODS Data from the British Association of Urological Surgeons (BAUS) Cancer Registry were linked to the UK Association of Cancer registries postcode directory. The demographic and clinical characteristics, and the initial management of men diagnosed with low‐risk localized prostate cancer in the UK between 2000 and 2006 were analysed. RESULTS In all, 43 322 cases of localized prostate cancer were recorded in the BAUS Registry between 2000 and 2006, of which 8861 (20%) met the criteria for low‐risk disease. The proportion classified as low risk ranged from 16% in 2000 to 21% in 2006. The proportion of men with low‐risk disease opting for ‘watchful waiting’ increased from 0% to 39% over the same period. Treatment choice was associated with socio‐economic status. For example, radical prostatectomy was chosen by 34% of patients in the most affluent quintile, compared with 19% in the most deprived quintile (P= 0.01). CONCLUSION The management of low‐risk localized prostate cancer in the UK has changed markedly in recent years, and contrasts with that in the USA. The association observed between socio‐economic status and choice of treatment deserves further study.

OBJECTIVES To describe national trends in the practice of radical nephrectomy (RN) in England between 1995 and 2002. METHODS Data were extracted from the Hospital Episode Statistics database of the Department of Health in England between 1995/1996 and 2001/2002. Patients were included in the study if an International Classification of Diseases diagnosis code (ICD‐10) for malignant neoplasm of the kidney, renal pelvis or ureter, and an operative procedure code (OPCS‐4) describing total or partial excision of the kidney by either a laparoscopic or open approach, were present in any of the diagnosis or operative procedure fields. Overall, 17 308 patients were included. RESULTS Patient age and the proportion who were men did not change over the study period. The proportion of patients admitted as an emergency decreased from 14.0% to 7.5% over this period (P < 0.001). The mean waiting duration increased by almost 6 days (P < 0.001) and length of stay by ≈ 1 day, from 11.7 days in 1995 to 10.8 days in 2001 (P < 0.001). In‐hospital mortality decreased from 2% to 1.5% (P = 0.134). In‐hospital mortality and length of stay were higher in older patients and in those admitted as an emergency. Women had a longer stay than men (11.5 vs 11.1 days), but in‐hospital mortality was higher in men (2.3% vs 1.6%). The national number of RNs per year increased by ≈ 20%, from 2254 in 1995 to 2671 in 2001. Over the same period the mean annual hospital volume of RN increased by ≈ 40%, from 17 in 1995 to 24 in 2001. The annual number of laparoscopic RNs nationally increased from seven in 1995 to 84 in 2002. CONCLUSIONS The annual number of RNs in England increased by almost a fifth and this was accompanied by an increase in annual hospital volume of about two‐fifths. There was a large proportional increase in the number of laparoscopic RNs. Emergency admission rates and length of stay decreased but this was not accompanied by a significant change in in‐hospital mortality rate.