Improvement goals supported by the NPCA

The Audit has the following priorities for quality improvement:

1. Reduce inequity in access to prostate cancer services and enable the best prostate cancer outcomes notwithstanding geographic area, socioeconomic deprivation, age, or ethnicity.
2. Reduce the proportion of men who have metastatic disease at the time of diagnosis
3. Maintain and where necessary improve fair access to all relevant diagnostic and therapeutic facilities, irrespective of the specific characteristics of the geographic region, the local prostate cancer services providers and the patients
4. Increase the use of multiparametric MRI before prostate biopsy
5. Increase the use of transperineal prostate biopsy to reduce the risk of post-biopsy sepsis and to maximise diagnostic accuracy and risk stratification
6. Reduce over-treatment with radical prostatectomy or radiotherapy of men diagnosed with low-risk prostate cancer
7. Reduce under-treatment of men diagnosed with high-risk or locally advanced prostate cancer using only androgen deprivation therapy, and – related to this – improve access to multimodal treatments
8. Reduce the occurrence of short-term and longer-term adverse events related to the diagnostic procedures and radical treatments
9. Increase the rate of cancer cure
10. Improve the overall care experience of men with prostate cancer, in particular the availability of specialist cancer nurses and the involvement of patients in the decision making about their treatment
11. Improve completeness of key clinical data items including performance status, stage, Gleason score and PSA.
12. Collect new COSD v9.0 data items including mpMRI pre-biopsy, MRI/FUSION biopsy and biopsy anaesthetic.

The Audit’s priorities for quality improvement are informed by:

1. Guidelines published by NICE and professional associations on the delivery of high-quality care by prostate cancer services and the related NICE Quality Standards.
2. Ongoing developments in the management of prostate cancer, in response to emerging evidence in a number of areas:

• Changes in the definition of clinically significant cancer with more men being diagnosed with clinically non-significant disease in order to way avoid risk of adverse events of radical treatment
• The increasing role of multiparametric MRI before prostate biopsy, which is expected to lead to a decrease in the number of prostate biopsies as well as an increase in the biopsies’ diagnostic value.
• A shift in prostate biopsy approach from transrectal to transperineal biopies, which will lead to a decrease in the risk of post-biopsy sepsis which has to be balanced against a possible increase in post-biopsy acute urinary retention.
• The rapid adoption of robotic-assisted laparoscopic prostatectomy, which aims to reduce the incidence of short-term and long-term adverse outcomes, compared to open or conventional laparoscopic surgery.
• Increased usage of advanced radiotherapy technologies, such as intensity-modulated radiotherapy and high-dose brachytherapy, delivering high-dose radiation with less exposure of the surrounding tissues compared to other radiotherapy modalities, reducing acute and late radiotherapy-related adverse events.

3. Ongoing changes in the regional organisation of cancer services:

• This will include monitoring of the centralisation of specialist services which may have a negative impact on access to treatment for patients who are older, less affluent and in a frailer state of health.