Time trends in prostate cancer surgery: data from an Internet-based multicentre database


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Abstract

Study Type – Therapy (individual cohort)Level of Evidence 2bWhat's known on the subject? and What does the study add?Treatment recommendations such as interdisciplinary guidelines are always based on scientific publications. However, high-quality studies are very often focused on single-centre series of selected cases. Health care research has failed to provide comprehensive information that describes the clinical reality of prostate cancer management even in smaller centres.This is a health care research study with 17 participating centres. Any prostate cancer centre can use the internet-based database http://prostata-ca.net, at no additional cost, to collect and analyze data for quality management, to conduct consecutive follow-up assessments, and to compare their data with the averages recorded by all other centres. The database also enables time trend analysis of certain quality parameters in an annual comparison.OBJECTIVESTo report our experience with an Internet-based multicentre database that enables tumour documentation, as well as the collection of quality-related parameters and follow-up data, in surgically treated patients with prostate cancer.The system was used to assess the quality of prostate cancer surgery and to analyze possible time-dependent trends in the quality of care.PATIENTS AND METHODSAn Internet-based database system enabled a standardized collection of treatment data and clinical findings from the participating urological centres for the years 2005–2009.An analysis was performed aiming to evaluate relevant patient characteristics (age, pathological tumour stage, preoperative International Index of Erectile Function-5 score), intra-operative parameters (operating time, percentage of nerve-sparing operations, complication rate, transfusion rate, number of resected lymph nodes) and postoperative parameters (hospitalization time, re-operation rate, catheter indwelling time).Mean values were calculated and compared for each annual cohort from 2005 to 2008. The overall survival rate was also calculated for a subgroup of the Berlin patients.RESULTSA total of 914, 1120, 1434 and 1750 patients submitted to radical prostatectomy in 2005, 2006, 2007 and 2008 were documented in the database.The mean age at the time of surgery remained constant (66 years) during the study period.More than half the patients already had erectile dysfunction before surgery (median International Index of Erectile Function-5 score of 19–20).During the observation period, there was a decrease in the percentage of pT2 tumours (1% in 2005; 64% in 2008) and a slight increase in the percentage of patients with lymph node metastases (8% in 2005; 10% in 2008). No time trend was found for the operating time (142–155 min) or the percentage of nerve-sparing operations (72–78% in patients without erectile dysfunction).A decreasing frequency was observed for the parameters: blood transfusions (1.9% in 2005; 0.5% in 2008), postoperative bleeding (2.6%; 1.2%) and re-operations (4.5%; 2.8%). The mean hospitalization time decreased accordingly (10 days in 2005; 8 days in 2008). The examined subcohort had an overall mortality of 1.5% (median follow-up of 3 years).CONCLUSIONSAn Internet-based database system for tumour documentation in patients with prostate cancer enables the collection and assessment of important parameters for the quality of care and outcomes.The participating centres show an improvement in the quality of surgical management, including a reduction of the complication rate.

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