“Black lives matter” when it comes to prostate cancer too

In an OpEd in today’s New York Times, there is a passionate plea for greater focus on the risks and dangers that prostate cancer presents to African-American men. … READ MORE …

Defining value in the management of prostate cancer

Many years ago, among his other famous quotations on the subject of prostate cancer, Willet Whitmore, considered by many to be the “father” of urologic oncology, stated the following: … READ MORE …

It was true 3 years ago, but is it still the case?

One of the problems with a lot of research is that it is out of date by the time it is published. The following example may be a classic case in point. And it has serious implications. … READ MORE …

PRIAS reports data from a 5,000+ patient active surveillance study

Data from a recent paper in European Urology has further confirmed the value of active surveillance as a first-line management option for men diagnosed with low-risk prostate cancer. It has also confirm recent guidance for when men on active surveillance actually need to be advised that treatment is probably wise. … READ MORE …

The role of active surveillance in prostate cancer management today

There is a new and very sound article by Gina Kolata in The New York Times (published online yesterday) addressing the expanding role of active surveillance as an initial management option for low-risk forms of prostate cancer. … READ MORE …

Current management of men with nmCRPC: a review

A new review article in the journal Oncology provides an excellent and relatively brief overview of the current options and recommendations for treatment of men with non-metastatic, castration-resistant prostate cancer (nmCRPC). … 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.

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