NPCA data collection on men undergoing radical surgery for prostate cancer Paul Cathcart, NPCA Urology Project Coordinator Senior Lecturer in Genitourinary Oncology Consultant Urological Surgeon, UCL & Barts

Surgeons perspective

The classic patient presenting in the clinic 62 year old chap Well man clinic – offered a PSA test Often asymptomatic Returns mildly elevated – 5.3 Referred to his local urologist

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Prostate biopsy

Patient assigned a Gleason grade for his tumour and a clinical stage Gleason score 6-10 (3+3, 3+4, 4+3, 4+4, 4+5, 5+4, 5+5)

Surgical Treatment

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Outcome of surgery

Minimum Dataset 2

Data Items Data item 1 – organisation site code CR1450 – The hospital identifier code Data item 2 - consultant code (treatment) CR0660 – Code of the consultant (derived from GMC code) that is responsible for the treatment of the patient No provision in COSD at present to document the surgeon who performs the procedure – NPCA will report surgeon level data on the basis of CR0660

Data Items Type of radical prostatectomy – Open – Robotic – Laparoscopic – Not known

Data Items Procedure nerve sparing – (bilateral, unilateral, none)

Data Items T category (pathological) N category (pathological) – Presence of tumour within regional Lymph nodal tissue

Data Items Clinical stage differs from pathological stage Up to 1/3 of men may be upstaged to T3 disease after surgery

Data Items Organ confined (Yes/No) – Aids completeness of staging – T2 – organ confined – T3 – locally advanced Seminal vesicle invasion

Data Items Radical prostatectomy margin status – Negative margins – Positive margins less than 3mm – Positive margins greater than or equal to 3 mm – Positive margin, length unknown Sooriakumaran P, Ploumidis A, Nyberg T, Olsson M, Akre O, Haendler L, Egevad L, Nilsson A, Carlsson S, Jonsson M, Adding C, Hosseini A, Steineck G, Wiklund P. The impact of length and location of positive margins in predicting biochemical recurrence after robotic-assisted radical prostatectomy with a minimum follow-up time of five years. BJU Int Oct 4.The impact of length and location of positive margins in predicting biochemical recurrence after robotic-assisted radical prostatectomy with a minimum follow-up time of five years.

Data Items Lymphadenectomy (Yes/No) Change to data item – Used to have number of positive nodes and number of nodes removed

Rationale for change in data item 174 patients who underwent PLND at two different hospitals PLND was performed according to a standardized template Mean number of reported lymph nodes was 16 at hospital A versus 28 at hospital B Overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS) were the same Pathological reporting markedly influences nodal yield The data item was therefore not felt reliable for national use Mertens LS, Meijer RP, van Werkhoven E, Bex A, van der Poel HG, van Rhijn BW, Meinhardt W, Horenblas S Differences in histopathological evaluation of standard lymph node dissections result in differences in nodal count but not in survival.World J Urol Oct;31(5): Differences in histopathological evaluation of standard lymph node dissections result in differences in nodal count but not in survival.

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