You are not being thick at all. Those two individual men may end up with exactly the same outcome but when you take the wider population, British men don't do as well as they should.
- Americans tend to have a family MD who has known them for many years, and knows the familial history so is more likely to be on the ball re small changes in the man's health
- Many Americans have private health cover which includes annual check ups so small PSA rises are noticed & closely monitored
- Apparently, American men are much more interested in their inner workings than British men and less likely to put off seeing the doctor
- all of this means that American men tend to be diagnosed earlier than ours, and rates of advanced PCa diagnosis are much lower
- Americans are more likely to have open RP which has slightly lower rates of positive margins and salvage treatment is less often needed
- Americans are slightly more likely to have RP followed by adjuvant RT regardless of pathology; this is still a trial approach in England (although it makes sense since that is a common approach to breast cancer, obviously the side effects are more likely to put off a man than a woman)
So basically, those two men may appear to be in exactly the same situation but the data suggests that they probably aren't - that the English man is more likely to have a higher grade than expected, or more cancer than expected, or to have a recurrence.
It is more interesting when you look at the adjustments for different parts of England. The regions where men are less likely to have a good outcome are more or less the same regions that have higher incidence of heart disease, obesity, diabetes, etc so outcomes are assumed to be linked to the same issues - poor diet, poor general health, poverty, reluctance to go to the GP, poor educational outcomes, lack of awareness of how your body works, and so on.
I don't think there is any data but I would guess that lack of confidence in challenging professionals / working class dis-empowerment may also affect outcomes. I would also guess that if you took out the middle-class and insurance-paying American population, the stats would show that poor Americans have much worse outcomes than any groups of British men. But that is only a guess.
Edited by member 19 Jun 2018 at 22:48
| Reason: typo