Quality Care

Prostate and Urologic Cancer

Prostate cancer is the most common solid tumor among American men. Each year, more than 100,000 men newly diagnosed with prostate cancer must decide where to be treated and what type of treatment to receive.

When choosing a care provider for prostate cancer, it’s helpful to review quality measures. The Prostate and Urologic Cancer Program at Froedtert & The Medical College of Wisconsin adheres to the following guidelines and standards for patient care.

Prostatectomy Report Card

In addition to the data found on this page, the Prostate and Urologic Cancer Program records extensive data on prostate removal surgery (prostatectomy).

National Comprehensive Cancer Network Guidelines for Prostate Cancer (NCCN) — the NCCN is a not-for-profit alliance of 21 of the world’s leading cancer centers and is dedicated to improving the quality and effectiveness of care provided to patients with cancer. NCCN guidelines are developed by a diverse panel of experts and updated as new information becomes available.
American Medical Association’s Physician Reporting Quality Initiative (PQRI) — in 2006, the Centers for Medicare and Medicaid Services required the establishment of a physician quality reporting system. This program is called the Physician Reporting Quality Initiative. Five PQRI measures for prostate cancer care are included in this study.
Froedtert & The Medical College of Wisconsin Prostate and Urologic Cancer Program Standards (PCP) — standards created by our program.

Newly Diagnosed Prostate Cancer Cases

The care quality measures listed below in the Quality Care Report Card are based on 30 cases of newly diagnosed, non-metastatic prostate cancer. All men received initial treatment at Froedtert & The Medical College of Wisconsin in the first six months of 2008.

Notable results:

All patients were offered specific information about treatment options
Care recommendations are based on each patient’s individual data, as required by NCCN guidelines
The need for additional tests (bone scan, CT scan) conforms to national guidelines
All cases underwent multidisciplinary team review for appropriate treatment
Fifteen of 19 patients received a first consult within five business days of first contact with the Prostate and Urologic Cancer Program²

Quality Care Report Card

Standard	Measure Source	Total¹	% Compliant
Documented: Multidisciplinary Consultation Offered Patients will be offered ability to meet with a urologic oncologist and radiation oncologist before treatment begins.	PCP	28/30	93%
Documented: Treatment Options Counseling Regardless of age, patients with clinically localized prostate cancer will receive counseling on (at a minimum) the following treatment options before treatment begins: active surveillance, interstitial prostate brachytherapy, external beam radiotherapy, radical prostatectomy.	PQRI	30/30	100%
Documented: Clinical T Stage Regardless of age and before treatment begins, patients with prostate cancer receiving interstitial prostate brachytherapy, external beam radiotherapy to the prostate, radical prostatectomy, or cryotherapy will receive documentation of evaluation of prostate-specific antigen (PSA) level, primary tumor (T) stage, and primary and secondary Gleason score.	PQRI	27/30	90%
Documented: Prostate-specific Antigen Level Regardless of age and before treatment begins, patients with prostate cancer receiving interstitial prostate brachytherapy, external beam radiotherapy to the prostate, radical prostatectomy, or cryotherapy will receive documentation of evaluation of prostate-specific antigen (PSA) level, primary tumor (T) stage, and primary and secondary Gleason score.	PQRI	30/30	100%
Documented: Primary Gleason Score Regardless of age and before treatment begins, patients with prostate cancer receiving interstitial prostate brachytherapy, external beam radiotherapy to the prostate, radical prostatectomy, or cryotherapy will receive documentation of evaluation of prostate-specific antigen (PSA) level, primary tumor (T) stage, and primary and secondary Gleason score. What is a Gleason score?	PQRI	29/30	97%
Documented: Secondary Gleason Score Regardless of age and before treatment begins, patients with prostate cancer receiving interstitial prostate brachytherapy, external beam radiotherapy to the prostate, radical prostatectomy, or cryotherapy will receive documentation of evaluation of prostate-specific antigen (PSA) level, primary tumor (T) stage, and primary and secondary Gleason score.	PQRI	29/30	97%
Bone Scan in High-Risk Patients⁴ Patients with a diagnosis of high risk prostate cancer will have a bone scan and a CT scan before treatment begins.	NCCN	5/5	100%
CT Scan in High-Risk Patients⁴ Patients with a diagnosis of high risk prostate cancer will have a bone scan and a CT scan before treatment begins.	NCCN	5/5	100%
Appropriate Use of Bone Scan in Low-Risk Patients³ Regardless of age, patients with a diagnosis of low risk prostate cancer receiving interstitial prostate brachytherapy, external beam radiotherapy to the prostate, radical prostatectomy, or cryotherapy will not have unnecessary imaging (bone scan and CT scan), unless there is documentation of a medical reason (e.g., pain, other medical reason).	PQRI	12/12	100%
Appropriate Use of CT Scan in Low-Risk Patients³ Regardless of age, patients with a diagnosis of low risk prostate cancer receiving interstitial prostate brachytherapy, external beam radiotherapy to the prostate, radical prostatectomy, or cryotherapy will not have unnecessary imaging (bone scan and CT scan), unless there is documentation of a medical reason (e.g., pain, other medical reason).	PCP	12/12	100%
Adjuvant Hormonal Therapy Offered for High-Risk Patients Receiving XRT⁴ (Three-dimensional radiation therapy) Regardless of age, patients with a diagnosis of prostate cancer who are at high risk of recurrence and who are receiving external beam radiotherapy to the prostate will receive adjuvant hormonal therapy.	PQRI NCCN	2/2	100%
Conformal Radiation Utilized for Patients receiving XRT (Three-dimensional radiation therapy) Regardless of age, patients with prostate cancer who are receiving external beam radiotherapy will receive 3D-CRT or IMRT (intensity modulated radiation therapy)	PQRI NCCN	6/6	100%

1. Total = number in compliance/number eligible for standard evaluation

2.Prostate Cancer hub initiated June 2007 (Percentage of patients that went through the hub: 87%) At Clinical Cancer Center, physicians, nurses and other caregivers are grouped by the kind of cancer they treat. Patients can access all the caregivers they need through a single cancer team. This approach is called the “hub model” because it puts the patient at the center, surrounded by all necessary physicians, nurses, resources and support. Within every cancer program, patients can count on a new patient coordinator and a nurse coordinator to guide them through the cancer journey. These coordinators make sure treatment proceeds smoothly, answer questions and provide resources. There is a specialized hub team for every kind of cancer to coordinate treatment and a seamless care experience.

3. LOW RISK:

PSA < 10; and
Gleason score 6 or less; and
Clinical stage T1c or T2a

4. HIGH RISK:

PSA > 20; or
Gleason score 8-10; or
Clinical stage T2c or greater

Gleason Score: A Gleason score is a way of grading prostate cancer. A higher score means a higher grade of tumor. Two Gleason grade numbers are determined and then added to get the final Gleason score. The lowest number on the Gleason grade scale is 1; the highest is 5. A pathologist looks at the biopsied tissue samples to determine where the cancer is most prominent (primary grade) and where it is “next most prominent" (secondary grade). He/she assigns a score (from 1 to 5) for the primary grade and an additional score for the secondary grade. The Gleason score is the sum of the primary and secondary grades and can range from 2 to 10.

The above information addresses the Institute of Medicine’s aim for health care that is timely, safe or effective.

Author: Marla Fraunfelder

Date: Aug. 1, 2009

Medical Reviewer:

William See, MD