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Improving quality in prostate cancer

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Quality indicators can provide reassurance that cancer care is achieving the predicted outcomes

Prostate cancer is a major health problem in Australia. In 2015, an estimated 17 250 men developed prostate cancer and 3440 died because of it.1 Localised prostate cancer is a particularly problematic disease in terms of decision making and even public policy. After many years, controversy still surrounds the benefits of prostate-specific antigen (PSA) screening.2 High level evidence for the management of localised prostate cancer is sparse when compared with that for other very common solid tumours, such as breast cancer and colon cancer.3 Large randomised clinical trials have been difficult to complete, perhaps because of the lack of equipoise among both clinicians and patients.4,5 Moreover, some men with prostate cancer have relatively indolent disease, and measuring the outcomes of treatment is complicated by the long follow-up time required.6 Comorbid health conditions may dominate the survival outcomes of men with localised prostate cancer. Finally, the benefits demonstrated in randomised controlled trials may not always be achieved in routine practice; specifically, smaller clinical trials may be undertaken by elite, high volume…