Wotz goin’ on in Canada? And wotz “True Nth”?

So apparently Prostate Cancer Canada has been working (rather secretively) on a series of projects under the umbrella name of their “True Nth” initiative. But it’s a little difficult to work out quite what is encompassed by this initiative, which has been funded (at least in part) by Movember. … READ MORE …

SBRT vs. moderate hypofractionation: same or better quality of life?

In several randomized clinical trials of external beam treatment of primary prostate cancer, we have seen that moderately hypofractionated intensity-modulated radiation therapy (HypoIMRT), accomplished in 12 to 26 treatments or fractions, is no worse than conventionally fractionated IMRT treatment (in 40 to 44 fractions). … READ MORE …

Outcomes, survival, and HRQOL in trials of new drugs (and what they mean in practice)

A new paper in the journal Quality of Life Research has raised the question of whether it is possible to use available quality of life data from Phase III trials of new drugs in the treatment of advanced prostate cancer to make rational decisions about the use of those drugs in clinical practice. … READ MORE …

Active surveillance in practice: probably not good enough as yet

As we have noted more than once before, a major problem with being managed on active surveillance is (potentially) whether one’s clinical management team really has been trained to conduct active surveillance in a sufficiently active manner. … READ MORE …

Can a man be too young for active surveillance?

There is a “conventional wisdom” that active surveillance (AS) is only for older men, and that younger men are better off having immediate radical treatment, typically prostatectomy (RP).

What does “value” mean for prostate cancer patients?

Many readers who weren’t able to join us on yesterday’s CureTalk panel discussion may want to listen to what was a wide-ranging discussion about things that are really valuable to prostate cancers patients at diagnosis and along their prostate cancer journey. … 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.