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Low-Risk Prostate Cancer Patients with No Record of Treatment Methodology

Low-Risk Prostate Cancer Patients with No Record of Treatment
Short description of Indicator Percentage of men with low-risk prostate cancer (aged ≥ 35) with no record of treatment (i.e. active surveillance, watchful waiting), 2012 to 2016​
Rationale for measurement Many prostate cancer cases are slow growing and will not cause harm (i.e., morbidity or death) in a man’s lifetime if left untreated. To mitigate the risks associated with over-treatment, active surveillance (i.e., monitoring the patient closely and providing definitive treatment only if the disease progresses) is recommended for many men with low-risk prostate cancer​
Evidence/references for rationale Program in Evidence-Based Care - Active Surveillance for the Management of Localized Prostate Cancer
https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/2286
Calculations for the indicator Number of low risk prostate cancer cases (ages 35 and older) with no record of treatment / Number of low risk prostate cancer cases (ages 35 and older) newly diagnosed in 2012-2016​
Standardized Rate Calculation N/A
Unit Percent​age (%)
Data sources Ontario Health (Cancer Care Ontario), Ontario Cancer Registry (OCR), Activity Level Reporting (ALR)

CIHI, DAD and NACRS data

Collaborative Staging Reporting Database (CRS Plus)
Time Frame CY2012-2016​
Geographic Scale Provincial​
Denominator description Risk categories are based on GUROC Consensus Risk Categories. To be classified as a low risk prostate cancer, it must meet all of the following criteria:
  • PSA ≤ 10ng/ml (i.e. 001 <= SSF1 <= 100)
  • Biopsy Gleason Score ≤ 6 (i.e. 002 <= SSF8 <= 006)
  • Clinical Stage T1-T2a (i.e. T1NOS, T1a, T1b, T1c, and T2a) and corresponding CS extension codes (i.e. 100, 130, 140, 150, and 210)
    Inclusions:
  • Males, age at diagnosis ≥ 35
  • ICDO3 codes C61.9 with behaviour code 3 (malignant)
  • Histology codes 8000-8110, 8140-8576, 8940-8950, 8980-8981
    Exclusions:
  • Lymphoma codes M-95 to M-98
  • M1 cases
  • Cases with invalid PSA values, Biopsy Gleason Score or Clinical Stage.
  • Cases with invalid Health Card Number (if required for linking to treatment data)
Numerator description To be classified as a low risk prostate cancer case with no record of treatment, they would not have received any of the following treatments within 1 year of diagnosis
  • Received radical prostatectomy (CCI code: 1QT91);
  • Received radiation therapy (external beam or brachytherapy).
Considerations
  • Use CS Extension – Clinical Extension to extract data for Stage
  • Use CS Site-Specific Factor 8 (SSF8) to extract data for Biopsy Gleason Score
  • Use CS Site-Specific Factor 1 (SSF1) to extract data for PSA Value
  • Stage T2NOS is treated as T2c
  • Valid Biopsy Gleason Score: cases with known Biopsy Gleason Score exclude cases with SSF8=988 (not applicable), SSF8=998 (no needle core biopsy/TURP performed), SSF8=999 (unknown or no information).
  • Valid PSA Value: cases with known PSA value, exclude cases with SSF1=988 (not applicable), SSF1=997 (test ordered, results not in chart), SSF1=998 (test not done), SSF1=999 (unknown or no information).
  • Valid Clinical Stage: cases with clinical stage, exclude cases with error, T0, TX
  • Please note that prostate cancer cases with no record of treatment cannot be all considered as active surveillance or watchful waiting because some cases could have refused treatments without active surveillance. But based on the available CCO data holdings, it’s difficult to determine the proportion of such cases.
Data availability & limitations It is expected to see high volumes of unknown or invalid codes for PSA value, Biopsy Gleason Score, and Clinical T stage. The impact of this data issue is not all cases were captured due to unknown or invalid codes for one or more of the three factors used to calculate risk category of prostate cancer cases. As a result, the number of low risk prostate cancer cases (aged ≥ 35) newly diagnosed in CY2012 – CY2016 might be under-estimated.