Table 1 Quality indicators (QI) for patients diagnosed with prostate cancer (PC) in canton Ticino, Southern Switzerland, between 01.01.2011 and 31.12.2013

QI1

Proportion of patients with prostate cancer and the diagnosis based on prostatic biopsy^a.

Number of patients with prostate cancer whose diagnosis was based on prostate biopsy^a.

535

Number of patients with prostate cancer.

700 of which 683 with available information.

78.3% (75.2%;81.4%)

Biopsy pathology report. Reports/discharge letters coming from all hospitals units/departments (i.e. surgery, medicine, radiation oncology, medical oncology).

Biopsy is the recognised diagnostic procedure.

QI2

Proportion of patients with prostate cancer and 8 or more diagnostic prostatic biopsies.

Number of patients with prostate cancer who underwent 8 or more diagnostic prostatic biopsies.

377

Number of patients with prostate cancer whose diagnosis was based on prostatic biopsy.

535 of which 520 with available information.

72.5% (68.7%;76.3%)

Biopsy pathology report. Request form of pathology examination.

A sufficient number of prostatic biopsies is required for an adequate sampling of the tissue.

QI3

Proportion of patients with prostate cancer and the pathology report of the biopsy including the following characteristics:

- histologic type according to WHO

- histologic grade with Gleason score

- tumour quantitation (number of positive cores/total number of cores and/or proportion of prostatic tissue involved by tumour).

Number of patients with prostate cancer whose pathology report of the biopsy included the histologic type according to WHO.

498

Number of patients with prostate cancer undergoing biopsy.

535 of which 528 with available information.

94.3% (92.3%;96.3%)

Biopsy pathology report.

Standardization of microscopic tumour characteristics is necessary for an adequate treatment planning.

Number of patients with prostate cancer whose pathology report of the biopsy included the histologic grade with Gleason score.

533

Number of patients with prostate cancer undergoing biopsy.

535 of which 534 with available information.

99.8% (99.5%;100.0%)

Number of patients with prostate cancer whose pathology report of the biopsy included tumour quantitation (number of positive cores/total number of cores and/or proportion of prostatic tissue involved by tumour).

524

Number of patients with prostate cancer undergoing biopsy.

535 of which 530 with available information.

98.9% (98.0%;99.8%)

QI4

Proportion of patients with prostate cancer and the pathology report of the TUR-P including the following characteristics:

- histologic type according to WHO

- histologic grade with Gleason score

- tumour quantitation (proportion of prostatic tissue involved by tumour).

Number of patients with prostate cancer whose pathology report of the TUR-P included the histologic type according to WHO.

74

Number of patients with prostate cancer undergoing TUR-P.

88 of which 81 with available information.

91.4% (85.2%;97.5%)

TUR-P pathology report.

Standardization of microscopic tumour characteristics is necessary for an adequate treatment planning.

Number of patients with prostate cancer whose pathology report of the TUR-P included the histologic grade with Gleason score.

79

Number of patients with prostate cancer undergoing TUR-P.

88 of which 84 with available information.

94.1% (89.0%;99.1%)

Number of patients with prostate cancer whose pathology report of the TUR-P included the tumour quantitation (number of positive cores/total number of cores and/or proportion of prostatic tissue involved by tumour).

59

Number of patients with prostate cancer undergoing TUR-P.

88 of which 81 with available information.

72.8% (63.1%;82.5%)

QI5

Proportion of patients with prostate cancer whose pathology report of the prostatectomy with pelvic lymphadenectomy includes the number of resected lymph nodes.

Number of patients with prostate cancer whose pathology report of the prostatectomy with pelvic lymphadenectomy included the number of resected lymph nodes.

195

Number of patients with prostate cancer undergoing prostatectomy with pelvic lymphadenectomy.

197 of which 195 with available information.

100.0% (100%;100%)

Prostatectomy pathology report.

Standardization of microscopic tumour characteristics is necessary for an adequate treatment planning.

QI6

Proportion of patients with prostate cancer and the pathology report of the prostatectomy including the following characteristics:

- histologic type according to WHO

- histologic grade with Gleason score

- extraprostatic extension

- seminal vescicle invasion

- margins status

- pathologic staging (pTNM) according to AJCC TNM 7th ed.

Number of patients with prostate cancer whose pathology report of the prostatectomy included the histologic type according to WHO.

198

Number of patients with prostate cancer undergoing prostatectomy.

220 of which 215 with available information.

92.1% (88.5%;95.7%)

Prostatectomy pathology report.

Standardization of microscopic tumour characteristics is necessary for an adequate treatment planning.

Number of patients with prostate cancer whose pathology report of the prostatectomy included the histologic grade with Gleason score.

219

Number of patients with prostate cancer undergoing prostatectomy.

220 of which 219 with available information.

100.0% (100%;100%)

Number of patients with prostate cancer whose pathology report of the prostatectomy included the extraprostatic extension.

198

Number of patients with prostate cancer undergoing prostatectomy.

220 of which 215 with available information.

92.1% (88.5%;95.7%)

Number of patient with prostate cancer whose pathology report of the prostatectomy included the seminal vescicle invasion.

210

Number of patients with prostate cancer undergoing prostatectomy.

220 of which 215 with available information.

97.7% (95.7%;99.7%)

Number of patients with prostate cancer whose pathology report of the prostatectomy included the margins status.

216

Number of patients with prostate cancer undergoing prostatectomy.

220 of which 220 with available information.

98.2% (96.4%;100.0%)

Number of patients with prostate cancer whose pathology report of the prostatectomy included the pathologic staging (pTNM) according to AJCC TNM 7th ed.

219

Number of patients with prostate cancer undergoing prostatectomy.

220 of which 220 with available information.

99.6% (98.7%;100.0%)

QI7

Proportion of patients with localized (N0, M0) low risk (cT1–2a and Gleason≤6 and PSA ≤ 10 ng/ml) prostate cancer undergoing active surveillance.

Number of patients with localized (N0, M0) low risk (cT1–2a and Gleason≤6 and PSA ≤ 10 ng/ml) prostate cancer who underwent an active surveillance.

33

Number of patients with localized (N0, M0) low risk (cT1–2a and Gleason≤6 and PSA ≤ 10 ng/ml) prostate cancer.

84 of which 71 with available information.

46.5% (34.9%;58.1%)

Reports/discharge letters coming from all hospitals units/departments (i.e. surgery, medicine, radiation oncology, medical oncology).

Guidelines indicate active surveillance as preferred treatment for low risk prostate cancers.

QI8

Proportion of patients with localized (N0, M0) high risk (cT3–4 or Gleason≥8 or PSA ≥ 20 ng/ml) prostate cancer undergoing radical treatment (radical prostatectomy ± pelvic lymphadenectomy, RT or brachytherapy).

Number of patients with localized (N0, M0) high risk (cT3–4 or Gleason≥8 or PSA ≥ 20 ng/ml) prostate cancer who underwent a radical treatment (radical prostatectomy ± pelvic lymphadenectomy, RT or brachytherapy).

144

Number of patients with localized (N0, M0) high risk (cT3–4 or Gleason≥8 or PSA ≥ 20 ng/ml) prostate cancer.

248 of which 208 with available information.

69.2% (63.0%;75.5%)

Reports/discharge letters coming from all hospitals units/departments (i.e. surgery, medicine, radiation oncology, medical oncology).

Guidelines indicate prostatectomy as 1st line treatment for high risk prostate cancers.

QI9

Proportion of patients with localized (N0, M0) high risk (cT3–4 or Gleason≥8 or PSA ≥ 20 ng/ml) prostate cancer undergoing radical RT with neo-adjuvant HT.

Number of patients with localized (N0, M0) high risk (cT3–4 or Gleason≥8 or PSA ≥ 20 ng/ml) prostate cancer who underwent a neo-adjuvant HT before radical RT.

66

Number of patients with localized (N0, M0) high risk (cT3–4 or Gleason≥8 or PSA ≥ 20 ng/ml) prostate cancer undergoing radical RT.

75 of which 75 with available information.

88.0% (80.7%;95.4%)

Reports/discharge letters coming from all hospitals units/departments (i.e. surgery, medicine, radiation oncology, medical oncology).

In high risk prostate cancer, treated with RT, the use of neo-adjuvant HT improves overall survival.

QI10

Proportion of patients with non-metastatic (M0) pT2 or pT3 prostate cancer undergoing prostatectomy ± pelvic lymphadenectomy with uninvolved margins^a.

Number of patients with non-metastatic (M0) pT2 or pT3 prostate cancer who underwent prostatectomy ± pelvic lymphadenectomy with uninvolved margins.

97 (pT2) 40 (pT3)

Number of patients with non-metastatic (M0) pT2 or pT3 prostate cancer undergoing prostatectomy ± pelvic lymphadenectomy.

118 (pT2)/97 (pT3) of which 118/97 with available information.

82.2% (pT2) (75.3%;89.1%) 41.2% (pT3) (31.4%;51.0%)

Prostatectomy pathology report.

Margins status is the only criteria for evaluating the radicality of the prostatectomy.

QI11

Proportion of patients with non-metastatic (M0) prostate cancer undergoing external beam RT with dose escalation to at least 74 Gy.

Number of patients with non-metastatic (M0) prostate cancer who underwent an external beam RT with dose escalation to at least 74 Gy.

148

Number of patients with non-metastatic (M0) prostate cancer undergoing RT.

198 of which 194 with available information.

76.3% (70.3%;82.3%)

Reports/discharge letters coming from all hospitals units/departments (i.e. surgery, medicine, radiation oncology, medical oncology).

RT dose escalation between 74 and 78 Gy increases biochemical control of prostate cancer.

QI12

Proportion of patients with metastatic (M1) prostate cancer undergoing immediate (within 3 months from the diagnosis) HT or bilateral orchiectomy.

Number of patients with metastatic (M1) prostate cancer who underwent HT or bilateral orchiectomy within 3 months from the diagnosis.

50

Patients with metastatic (M1) prostate cancer.

74 of which 68 with available information.

73.5% (63.0%;84.0%)

Reports/discharge letters coming from all hospitals units/departments (i.e. surgery, medicine, radiation oncology, medical oncology).

HT is the indicated treatment for metastatic prostate cancer.

QI13

Proportion of patients with non-metastatic (M0) prostate cancer dead within 30 days after prostatectomy ± pelvic lymphadenectomy (post-operative mortality).

Number of patients with non-metastatic (M0) prostate cancer who died within 30 days after prostatectomy ± pelvic lymphadenectomy.

1

Number of patients with non-metastatic (M0) prostate cancer undergoing prostatectomy ± pelvic lymphadenectomy.

219 of which 219 with available information.

0.5% (0.0%; 1.4%)

Reports/discharge letters coming from all hospitals units/departments (i.e. surgery, medicine, radiation oncology, medical oncology).

Indicator for the outcome after radical prostatectomy.