Objective• To describe the characteristics of patients with and without positive surgical margins (PSMs) and to analyse the impact of PSMs on secondary cancer treatment after radical prostatectomy (RP), with short-term follow-up. Patients and Methods• We analysed data from 2385 consecutive patients treated using RP, who were notified to the Prostate Cancer Registry by 37 hospitals in Victoria, Australia between August 2008 and February 2012.• Independent and multivariate models were constructed to predict the likelihood of PSMs. Independent and multivariate predictors of secondary treatment after RP in the initial 12 months after diagnosis were also assessed. Results• Conclusions• These data indicate an important association between hospital status and PSMs, with patients who underwent RP in private hospitals less likely than those in public hospitals to have a PSM. Patients treated in lower-volume hospitals were more likely to have a PSM and less likely to receive additional treatment after surgery in the initial 12 months, and robot-assisted RP was associated with fewer PSMs than was open RP in this non-randomized observational study.

Objective: To analyse the performance of the quality of prostate cancer (CaP) care over a 5‐year period with reference to three quality indicators (QIs) reported by the Prostate Cancer Outcomes Registry–Victoria (PCOR‐Vic):
QI‐1: Alignment with the modified Prostate Cancer Research International Active Surveillance (PRIAS) protocol guideline;
QI‐2: Timeliness of CaP care for men with high risk and locally advanced disease;
QI‐3: Positive surgical margins (PSMs) for organ‐confined pathological T2 disease. Design, setting and participants: Between 1 January 2009 and 31 December 2013, 4708 men diagnosed with CaP who met the QI‐1, QI‐2 or QI‐3 inclusion criteria were recruited from Victorian hospitals. Outcome measures and statistical analysis: Trend analysis was conducted to monitor performance according to QI‐1, QI‐2 and QI‐3. We used the autoregressive integrated moving average (ARIMA) model to account for any inherent autocorrelation in the data when analysing the monthly incidence of each indicator. Differences in the annual figures for the indicators across years were also analysed by aggregating data by year and applying the ARIMA model. Results and limitations: There was a downward trend over the 5 years in the percentage of men with low risk disease who underwent active treatment (45% to 34%; P = 0.024), an upward trend in the percentage of those with high risk and locally advanced disease who received active treatment within 12 months of diagnosis (88% to 93%; P = 0.181), and a decline in PSM rate in men with pathological T2 disease after radical prostatectomy (21% to 12%; P = 0.036). Limitations of the study include the fact that the improvement in the QIs was detected using PCOR‐Vic as a single population, but there may be institutional variations in quality improvement. Conclusions: Over 2009–2013, the performance of the Victorian health system improved according to the three processes of care indicators reported by the PCOR‐Vic.

We report on a large population-based comparative study of ORP and RARP with better short-term oncological outcomes favouring RARP, but no significant differences in HRQOL outcomes. The results have to be interpreted taking into account significant surgeon heterogeneity in a population-based study.

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The known Active surveillance is increasingly employed to manage men with low risk prostate cancer, both to avoid unnecessary treatment and to monitor them in a manner that allows detection of progression that would justify deferred radical treatment.The new Active surveillance was not implemented according to published protocols in 73.5% of men diagnosed with low risk prostate cancer in this Victorian cohort study.The implications The reasons for poor adherence to active surveillance require further investigation. It may reflect patient-, clinician-, and health service-related factors. Lack of surveillance increases the risk that men miss the opportunity to be treated with curative intent. L ow risk prostate cancer is increasingly being managed with active surveillance (AS). The objectives of AS are to avoid unnecessary treatment, but to monitor men with low risk cancer according to a protocol that facilitates recognition of progression which justifies deferred radical treatment with curative intent. 1While AS has become an accepted management tool, evidence for the optimal frequency of monitoring and the most appropriate triggers for intervention is scarce.2 Several AS protocols and guidelines with differing inclusion and follow-up criteria have been published (Box 1). The recommended frequency for measuring prostate-specific antigen (PSA) levels ranges from every 3 2,3,5 to every 6 months, 7,8 and the European Association of Urology guidelines acknowledge that the available evidence is inadequate for defining optimal timing.6 It is generally accepted, however, that the first follow-up biopsy should be undertaken within 12 months of diagnosis; 2-5,7 the recommended timing of subsequent biopsies ranges from annually 5 to once every 5 years. 7The main shortcoming of all AS protocols and guidelines is that they have not been validated in randomised controlled trials. Men are eligible for inclusion if they have a diagnosis of prostate cancer, have presented for diagnosis or treatment at a recruiting hospital, and are being treated by a clinician who has provided consent for patients to be approached and enrolled by the registry. After ethics approval has been granted, a hospital authorises the Victorian Cancer Registry (VCR) to release all prostate cancer notifications from that hospital to PCOR-Vic. Ethics approval for the PCOR-Vic was initially granted in March 2009, with permission to retrospectively collect data for men diagnosed from August 2008. The PCOR-Vic is able to assess the population coverage of its data by comparing them with summary notification data from the VCR for men who have received a diagnosis of malignant neoplasm of the prostate (International Classification of Diseases [ICD] code C61) or for whom a prostate biopsy pathology result was reported. This matching process has established that PCOR-Vic captures data from both public and private hospitals for 75% of patients with prostate cancer in Victoria.In Victoria, 60% of men diagnosed with low risk prostate cancer are managed with AS.13 This...