Formal comment from ASTRO on the results of the ProtecT trial

The following official statement was issued on September 15 by the American Society for Radiation Oncology (ASTRO): … READ MORE …

Improvements in the quality of prostate cancer care (in Australia)

One of the most critical issues for many in the prostate cancer community is whether patients actually receive treatment according to standard guidelines. While getting treatment according to standard guidelines may not imply that a patient is getting the very best possible care, we know that getting treatment according to standard guidelines does at least mean that physicians are seeking to meet or surpass the quality of care that is recommended.

A new paper by Sampurno et al. in the Medical Journal of Australia has provided us with data from the Prostate Cancer Outcomes Registry–Victoria (PCOR-Vic), a state-wide prostate cancer outcomes registry in Victoria (one of Australia’s most highly populated states).

The authors collected and analyzed data on 4,708 men diagnosed with prostate cancer over a 5-year period (from 1 January 2009 and 31 December 2013). The goal was to assess how well prostate cancer care was being delivered when measured against three predefined quality indicators:

  • Alignment with the modified Prostate Cancer Research International Active Surveillance (PRIAS) protocol guideline (QI-1)
  • Timeliness of prostate cancer care for men with high-risk and locally advanced disease (QI-2)
  • The presence of positive surgical margins (PSMs) among men treated surgically for organ-confined, pT2 disease (QI-3)

The entire text of this paper is available on line for interested readers, so we will focus on the “top-line” results of the study, as follows:

  • Over the 5 years of the study there was
    • A downward trend in the percentage of men with low-risk disease who underwent active treatment (from 45 to 34 percent; P = 0.024)
    • An upward trend in the percentage of men with high-risk and locally advanced disease who received active treatment within 12 months of diagnosis (from 88 to 93 percent; P = 0.181)
    • A decline in PSM rate among men with pT2 disease after radical prostatectomy (from 21 to 12 percent; P = 0.036)

The authors note that a limitation of the study is that the improvement in the quality indicators was detected using PCOR-Vic as a single population, but that there could still be institutional variations in quality improvement.

With that reservation, the authors conclude that, over the period 2009 t0 2013

the performance of the Victorian health system improved according to the three processes of care indicators reported by the PCOR-Vic.

The “New” Prostate Cancer InfoLink sees this as an important study because it offers (a) validation of the processes being used in Australia to set and then achieve certain standards of care and (b) a significant set of improvements over 5 years toward achieving such standards of care.

By comparison, in much of America, there are no predefined goal being set by anyone as to levels of acceptable outcomes, nor are there clear educational processes in most states designed to ensure that physicians are seeking to meet or exceed such outcomes.

The appropriate implementation of active surveillance as a management strategy

In addition to the prior article on management of low-risk prostate cancer in Canada comes another article that highlights the importance of what is called “active surveillance” (as opposed to what may actually be much less sophisticated forms of monitoring). … READ MORE …

Active surveillance common in Ontario; less so elsewhere in Canada

Recent data suggest that active surveillance is now becoming a commonplace form of management in the province of Ontario for Canadian men with low-risk forms of prostate cancer. … READ MORE …

Why we should care about standards of care?

“Standard of care” (SOC) is a legalistic term. As it applies to medicine, wh en a clinician follows an SOC, it means that he or she has proceeded with the reasonable caution that any minimally competent doctor would and should exercise in such circumstances. … READ MORE …

Assessing the “value” of treatment with specific drugs (here in the USA)

Last Friday, the National Comprehensive Cancer Cancer Network (NCCN) introduced a new way for doctors and patients to be able to consider the clinical “value” of treatment with specific drugs in specific forms of cancer. How useful this method is will take a while to work out. … READ MORE …

Guidelines and the current treatment of mCRPC

The December 1 issue of The ASCO Post contains two articles that will be of interest to many patients with progressive disease and their family members. … READ MORE …