gms | German Medical Science

Introduction and Objective: Reports on the effectiveness and morbidity of prostate therapies like radical prostatectomy originate almost exclusively from monocenter series of larger centers. It remains unclear to what extent this characterization is representative.

With the aim of continuously improving treatment quality, multicenter perioperative data encompassing all standard forms of prostate therapy (RPX, 3D-RTX, seeds) have been collected since January 2004 in the region of Berlin and Kassel. This study is directed by the Tumorzentrum Berlin.

Methods: An Internet-based databank is used: http://www.prostata-ca.net. Apart from documentation of all clinically relevant parameters associated with the intervention (e.g., morbidity, particularly blood loss; oncosurgical quality: number of excised lymph nodes, rate of positive surgical margins, etc.), the follow-up is also covered via the system (e.g., PSA course, continence, potency (IIEF-5), RTOG score).

Evaluation of results between hospitals is not done as a ranking list but as a benchmarking graph depicting the achievement of one’s own clinic in comparison to the average of all other clinics.

Results: Seventeen clinics took part in the documentation. Radiotherapeutic clinics have not yet been included. After 9 months, 669 patients were filed, 2/3 of them completely documented. An average of 34.7 patients were entered per clinic (1-387 patients). Data were recorded on 396 radical retropubic operations and 273 perineal interventions. The mean postoperative hemoglobin value was 11.9 g/dl (6.4 - 13g/dl). The resultant mean Hb difference from the preoperative value was only 3.1 g/dl. The transfusion rate in the total population was 0.59%. The indwelling catheter was left in place for a mean period of 8 days (3-35); the mean hospitalization period was 11 days (1 - 98). There was considerable oncosurgical variance: the overall rate of positive surgical margins was 25% (18% - 37%). On the average, a lymphadenectomy involved removing a total of 11 lymph nodes (pelvic on both sides) (2 - 32). Follow-up data are still too limited for analysis.

Conclusions: Prerequisites for fair benchmarking and quality control include sound and reliable quality indicators as well as adequate adjustment of patient-related risk factors, because they decisively influence the achievement quality. Positioning the achievements of one’s own clinic in comparison to all other clinics may be instrumental in bringing about a marked improvement of treatment quality.