Prostate-Specific Antigen Kinetics After Hypofractionated Stereotactic Body Radiation Therapy Boost as Post-External Beam Radiation Therapy (EBRT) Versus Conventionally Fractionated EBRT for Localized Prostate Cancer

Abstract

Measures, RAND, and American College of Surgeons Commission on Cancer-endorsed quality-of-care measures. Results: We found excellent compliance with metrics focusing on the accuracy and completeness of staging and management documentation. Completeness of TNM staging, biopsy and surgical pathology reporting, and assessment of baseline urologic and sexual function was 100%. This was also true for discussion of active surveillance management in appropriate cases. Assessment and documentation of post-treatment quality-oflife outcomes increased for surgical and radiation therapy management outcomes. Specific effort was made on the PQRS clinical care objective for adjuvant hormonal therapy for high-risk prostate cancers. For unfavorable intermediate-risk cases, 55% of patients were advised on combined therapy, with only 22% receiving concurrent therapies. For high-risk prostate cancers, 100% of patients were advised on receiving hormonal therapy, with 76% ultimately receiving combined hormone ablation and radiation therapy. For high-risk patients, an increase in completing comprehensive evaluations with medical and radiation oncology consultations in addition to surgical consultation was achieved: Before implementing the high-risk management guidelines, 60% of patients completed medical and/or radiation oncology consultations. With best practice guidelines, 87% of patients completed comprehensive multidisciplinary consultations before initiation of definitive treatment, resulting in a significant reduction in the number of high-risk patients managed surgically. Conclusion: Implementation of an institutional provider-directed initiative based on established metrics achieved improvements in appropriate and effective clinical care based on established quality metrics. Continued improvements can be realized in the multidisciplinary management of advanced and high-risk prostate cancers.