Prostate Cancer Measurability of Quality Performance Indicators Version 3.0

Transcription

1 Prostate Cancer Measurability of Quality Performance Indicators Version 3.0 To be read in conjunction with: Prostate Cancer Clinical Quality Performance Indicators V3.0 (July 2016) Prostate Cancer Data Definitions (latest published version) (For patients diagnosed from 01/07/15)

2 Measurability of Quality Performance Indicators for Prostate Cancer Please refer to the Prostate Cancer Quality Performance Indicators published by Healthcare Improvement Scotland for a full description of individual QPIs Please refer to the Prostate Cancer QPI Dataset published by ISD Scotland for a full description of individual data items Document control: This version Title Prostate Cancer Measurability of QPIs Version/Issue Number Version July 2015 (where amended or new QPIs require new data items for Effective From Author Charlotte Anthony ISD measurement this will apply for patients diagnosed from 1 st July 2016) Document Type Guidance Document status Final for publication Document Purpose To outline how QPIs should be measured using the agreed National Minimum Core Data Set Summary of changes Amendments made out-with review Revision History Version Date Status Summary of Changes QPI (s) 1.0: April /4/2012 Final Finalised following public engagement All 1.0: May /5/2012 Update to format as agreed at meeting of QPI working group 9/5/2012 All 1.0 June /6/2012 Changes to reflect updated dataset QPI June /6/2012 Changes to reflect dataset QPI 2 1.2: Dec /12/2012 Update of format for not recorded specification as requested by BM All 1.3: Feb /02/2013 Final Update of format for not recorded specification as agreed with Roger Black Jan 2013 & checked All against updated dataset 2.0: Dec /03/2013 Final Amendments made as per agreed changes following 9 month review, updated with new MDT QPI, and checked against published QPIs and dataset. 2.1: Jan /01/2014 Final Correct issues with specification not including all patients) : July /07/2014 Final Amendments made out-with review, incorporating additional data item into the dataset updating 2,4,5,8 the MDT QPI 2.3 Nov /11/2014 Final Amendments made out-with review (initial Baseline change). 5,8 2.4: Jan /01/2015 Draft Baseline review updates made 2, 4,7 & Mar /03/2015 Final Baseline review updates published 2, 4,7 & Apr /04/2015 Draft Change made out-with review following Baseline comments 2 & Apr /04/2015 Final Change made out-with review following Baseline comments 2 & May /05/2015 Final Changes made out with review following analysis 1 st and 2 nd year reporting Nov /11/2016 Final Amendments made as per agreed changes following Formal Review 1, 2, 3, 4, 6, 7, 8, 9, 10, 11, 12

3 Updates from Previous Version QPI Summary of changes Nov 2016 (excluding formatting changes) Description inserted by pathology ; Numerator inserted by pathology, AND Number of Needle Cores Received (targeted) + [NUMCORESRECT]) 10; Denominator 1 change excludes to excluding, inserted or TRUS (mpmri fusion biopsy) [SPECTYPE = 1 or 3] ; NR for Numerator inserted OR [NUMCORESRECT = 99] Description inserted the following text Please note: The specifications of this QPI are separated to ensure clear measurement of patients with: (i) Intermediate risk prostate cancer who undergo MRI; and (ii) High risk prostate cancer who undergo MRI and bone scan ; Numerator (i) removed text (or alternative 2 whole body MRI evaluation) ; Denominator (i) within TNM Tumour Classification removed or T2c and inserted T2c or in the TNM Tumour Classification not coded as..., c removed from T3, T3a, T3b and T4; Denominator (ii)inserted T2c or within TNM Tumour Classification and c removed from T3, T3a, T3b and T4..., c removed from T3, T3a, T3b and T4 Description inserted of QPI document ; Numerator inserted of QPI document ; Denominator removed TRUS and inserted Transrectal Ultrasound Guided Biopsy OR 3 Transrectal Ultrasound Guided Biopsy (mpmri fusion biopsy) OR 3 QPI Title removed with newly diagnosed prostate cancer ; Description inserted the following text Please note: The specifications of this QPI are separated to ensure clear measurement of patients with:(i) Non-metastatic prostate cancer (TanyNanyM0); and (ii) Metastatic prostate cancer (TanyNanyM1). ; Numerator now split to (i) & (ii), Numerator (i) inserted non-metastatic and (TanyNanyM0); Denominator now split to (i) & (ii), Denominator (i) replaced diagnosed with to with non-metastatic 4 inserted (TanyNanyM0), inserted AND TNM Metastases Classification (Clinical) (Cancer of the Prostate) coded as : No distant metastasis Type of First Cancer Treatment not coded as Patient Died Before Treatment [cm = M0] AND; Numerator (ii) and Denominator (ii) see main document for detail; NR Denominator inserted [cm = 99] Numerator changed to Specification and inserted the following text It is recommended that where two consultants operate together on the same patient the case 6 should be counted under the Lead Surgeon. Rows Denominator, NR Numerator, NR exclusion and NR Denominator have all been deleted. QPI 7 was Hormone Therapy now Hormone Therapy and Docetaxel Chemotherapy ; QPI Title inserted and chemotherapy where appropriate and inserted the following footers * Immediate hormone therapy would be within 31 days of MDT meeting (pre-treatment). * LHRH agonist / antagonist monotherapy, dual androgen blockade or bilateral orchidectomy. * Docetaxel should be started within 90 days of first dose of hormone therapy. ; Description removed who are managed with any hormone therapy licensed in this indication as monotherapy or in combination with an anti-androgen for maximum androgen blockade, or bilateral orchidectomy. Note: Developing new LHRH agonists may be included when SMC licensing for appropriate use approved inserted and docetaxel chemotherapy and Please note: The specifications of this QPI are separated to ensure clear measurement of patients who receive (i) Immediate hormone therapy; 7 and (ii) Immediate hormone therapy and docetaxel chemotherapy. ; Numerator now split to (i) & (ii), Numerator (i) removed (LHRH agonist monotherapy, maximum androgen blockade or bilateral orchidectomy), or Orchidectomy inserted presenting with metastatic prostate cancer (TanyNanyM1), or Gonadorelin Antagonist, Orchidectomy or ; Denominator now split to (i) & (ii), Denominator (i) inserted Type of Hormone Therapy not coded as : Patient refused replaced NOT with AND Patient Entered into Clinical Trial inserted not coded as..., removed AND NOT Type of Hormone Therapy coded as Patient refused ; Numerator (ii) and Denominator (ii) see main document for detail; NR Numerator split to (i) & (ii), inserted (ii) [HORMDATE = 09/09/0909] OR [MDTDATE =09/09/0909] OR [HORMAGENT = 99] OR [CHEMAGENT = 99] OR [CHEMDATE = 09/09/0909] ; NR Exclusion split to (i) & (ii), inserted (ii) [HORMTYPE = 99] OR [CHEMAGENT = 99] OR [TRIAL = 99] Numerator (i) & (ii) inserted undergoing radical prostatectomy and measured using a validated tool** 3pads/day amended to 2 pads/day and removed OR 8 incontinent ; Denominator amended 6 months to 12 months, and 180 days to 365 days. 9 QPI ARCHIVED 10 QPI ARCHIVED 11 Inserted new QPI Early Management of Active Surveillance 12 Inserted new QPI 30 Day Mortality Following Chemotherapy QPI 6 Summary of changes May 2015 (excluding formatting changes) Numerator inserted the following text - Number of radical prostatectomies performed by each surgeon in a given year. No exclusions. Number of operations (MainOp or Op1 or Op2 or Op3 = {M611 or M612 or M613 or M614 or M619}) perfomed by each surgeon where operation date is within time period specified. NB: If clinician responsible for relevant operation is not recorded, consultant/hcp responsible for care is used instead and this should be noted. QPI Summary of changes (excluding formatting changes) April 2015 Denominator (i) changes made to exclude High Risk patients: (([ct = T2b OR T2c] AND [GTOTAL < 8] AND [PSA 20.0]) OR ([GTOTAL = 7] AND [ct <> T3 OR T3a OR T3b OR T4] AND [PSA 20.0]) OR ([PSA 10.0 AND 20.0] AND [ct <> ct3 OR ct3a OR ct3b OR ct4] AND [GTOTAL < 8]) 2 added and ( [ct = ct3 OR ct3a OR ct3b OR ct4] OR [GTOTAL = 8 OR 9 OR 10] OR ( [PSA >20] AND [PSA <> ] AND [PSA <> ] ) removed. NR for Denominator. ([ct = 99] AND ([GTOTAL < 8] OR [GTOTAL = 99]) AND ([PSA 20] OR [PSA = ] OR [PSA =

4 ])) OR ([GTOTAL = 99] AND [ct<> T3 or T3a or T3b or T3c or T4] AND ([PSA 20] OR [PSA = ] OR [PSA = ])) OR ([PSA = ] AND [ct <> T3 or T3a or T3b or T3c or T4] AND ([GTOTAL < 8] OR [GTOTAL = 99])) OR ([TYPESURG = 99] AND [RADIO <> 3] AND [BRACHYDATE = 10/10/1010]) OR ([RADIO = 99] AND [TYPESURG <> 1] AND [BRACHYDATE = 10/10/1010]) added and [ct = 99] AND [GTOTAL = 99] AND [PSA = ] OR ( [TYPESURG = 99] AND [RADIO = 99] ) OR [BRACHYDATE = 09/09/0909] removed. Changed to calculation agreed for Bladder 9-month review changed to [MDTDATE <> 10/10/1010] AND ([MDTDATE DEFTREATDATE] OR [DEFTREATDATE = 10/10/1010]) QPI Summary of changes (excluding formatting changes) March Split QPI reporting into two distinct elements. Remove OR [MAJGGRADE] = 99 OR [MINGGRADE] = 99 from NR denominator. 4 Add OR [DEFTREATDATE <> 10/10/1010] to numerator. 7 Change from 14 days to 31 days 9 Change NR for numerator to ([URIMORBID = 99] AND [BOWMORBID <> 3 OR 4 OR 5]) OR ([BOWMORBID = 99] AND [URIMORBID <> 3 OR 4 OR 5]) QPI Summary of changes (excluding formatting changes) November 2014 replace 'Retropubic prostatectomy; OR Transvesical prostatectomy' text with 'Radical prostatectomy' and remove 'M61.2 OR M61.4 OR' from calculation in 5 denominator specification replace 'Retropubic prostatectomy; OR Transvesical prostatectomy' text with 'Radical prostatectomy' and remove 'M61.2 OR M61.4 OR' from calculation in 8 denominator specification QPI Summary of changes (excluding formatting changes) July 2014 Corrected not recorded value for PSA ( ) in not recorded for denominator. Added OR ([GTOTAL = 99] AND ([MAJGGRADE] + [MINGGRADE] = 7 or 8 or 9 2 or 10)). AND [PSA <> )) 4 Amended MDT QPI 5 Remove M34.1 from denominator 8 Remove M34.1 from denominator QPI Summary of changes (excluding formatting changes) Jan Amended denominator to include patients with M1a, M1b and M1c disease. 2 Removed duplicate of denominator calculation from numerator and corrected syntax of denominator specification. 3 Removed PSA from numerator as this is not a required field on Scottish Prostate Needle Biopsy Dataset. 4 Inserted new MDT QPI measurability. 5 Previously QPI 4 6 Previously QPI 5 7 Previously QPI 6. Updated to include LHRH antagonists. 8 Previously QPI 7 9 Previously QPI 8 10 Previously QPI 9

5 QPI 1: Biopsy Procedure QPI Title: Procedure for performing prostate biopsy should be optimised. Description: Numerator: Proportion of patients with prostate cancer who undergo trans-rectal ultrasound guided (TRUS) prostate biopsy for histological diagnosis where a minimum of 10 cores are received by pathology. Number of patients with prostate cancer who undergo TRUS biopsy where a minimum of 10 cores are received by pathology. Number of Needle Cores Received (Right-Left) AND Number of Needle Cores Received (targeted) greater than or equal to 10 ([NUMCORESRECR] + [NUMCORESRECL] + [NUMCORESRECT]) 10 Denominator: All patients with prostate cancer who undergo TRUS biopsy of the prostate (Excluding patients enrolled in clinical trials, and patients with advanced (T4NanyMany) or metastatic disease (TanyNanyM1)). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis AND Type of Specimen for Histological Diagnosis (Prostate Cancer) coded as TRUS or TRUS (mpmri fusion biopsy); AND Patient Entered into Clinical Trial {Prostate Cancer} not coded as yes; AND TNM Metastases Classification (Clinical) (Cancer of the Prostate) NOT coded as: Distant metastasis; AND TNM Tumour Classification (Clinical) (Cancer of the Prostate) NOT coded as: Tumour is fixed or invades adjacent structures other than seminal vesicles [SPECTYPE = 1 or 3] AND [TRIAL <> 1] AND [ct <> T4] AND [cm <> M1 OR M1a OR M1b OR M1c] numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [NUMCORESRECR OR NUMCORESRECL = 99] OR [NUMCORESRECT = 99] exclusion Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. [TRIAL = 99] OR [cm = 99] OR [ct = 99] denominator Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [SPECTYPE = 99]

6 QPI 2: Radiological Staging QPI Title: Patients with intermediate or high risk prostate cancer who are suitable for radical treatment, should be evaluated for locally advanced, nodal or bony metastatic disease. Description: Proportion of patients with intermediate and high risk prostate cancer undergoing radical treatment who have had MRI and bone scan staging. Please note: The specifications of this QPI are separated to ensure clear measurement of patients with: (i) Intermediate risk prostate cancer who undergo MRI; and (ii) High risk prostate cancer who undergo MRI and bone scan Numerator (i) Number of patients with intermediate risk prostate cancer undergoing radical treatment who have an MRI of the prostate. Imaging Investigations Complete coded as: Complete MRI and Isotope Bone Scan or Whole Body MRI OR Incomplete MRI of Prostate only IMAGE = 1 OR 2C Denominator (i) All patients with intermediate risk prostate cancer undergoing radical treatment. (Excluding Patients unable to undergo an MRI scan, and Patients who refuse MRI) Date of Diagnosis in range specified for comparative analysis AND (TNM Tumour Classification (Clinical) (Cancer of the Prostate) coded as: T2b AND Gleason Total score coded as: less than 8 AND Prostate Specific Antigen at Diagnosis less than or equal to 20) OR Gleason Total score equal to 7 AND TNM Tumour Classification (Clinical) (Cancer of the Prostate) not T2c or T3 or T4 AND Prostate Specific Antigen at Diagnosis less than or equal to 20 OR Prostate Specific Antigen at Diagnosis greater or equal to 10 AND less than or equal to 20 AND TNM Tumour Classification (Clinical) (Cancer of the Prostate) not T2c or T3 or T4 AND Gleason Total score coded as: less than 8 AND (Type of Surgery coded as: Radical; OR External Beam Radiotherapy Course Type coded as: Radical; OR Brachytherapy Date not coded as: inapplicable ) AND Imaging Investigations Complete not coded as 2A or 95 (([ct = T2b] AND [GTOTAL < 8] AND [PSA 20.0]) OR ([GTOTAL = 7] AND [ct <> T2c OR T3 OR T3a OR T3b OR T4] AND [PSA 20.0]) OR ([PSA 10.0 AND 20.0] AND [ct <> T2c OR T3 OR T3a OR T3b OR T4] AND [GTOTAL < 8])) AND ( [TYPESURG = 1] OR [RADIO = 3] OR [BRACHYDATE <> 10/10/1010] ) AND [IMAGE <> 2A OR 95] Numerator (ii) Number of patients with high risk prostate cancer undergoing radical treatment who have an MRI of the prostate and isotope bone scan (or alternative whole body MRI evaluation). IMAGE = 1

7 Denominator (ii) All patients with high risk prostate cancer undergoing radical treatment. (Excluding Patients unable to undergo an MRI scan, and Patients who refuse MRI) Date of Diagnosis in range specified for comparative analysis AND (TNM Tumour Classification (Clinical) (Cancer of the Prostate) coded as: T2c or T3 or T3a or T3b or T4 OR Gleason Total score coded as: 8 or 9 or 10 OR Prostate Specific Antigen at Diagnosis greater than 20) AND (Type of Surgery coded as: Radical; OR External Beam Radiotherapy Course Type coded as: Radical; OR Brachytherapy Date not coded as: inapplicable ) AND Imaging Investigations Complete not coded as 2A or 95 ( [ct = T2c OR T3 OR T3a OR T3b OR T4] OR [GTOTAL = 8 OR 9 OR 10] OR ( [PSA >20] AND [PSA <> ] AND [PSA <> ] ) ) AND ( [TYPESURG = 1] OR [RADIO = 3] OR [BRACHYDATE <> 10/10/1010] ) AND [IMAGE <> 2A OR 95] numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [IMAGE = 99] exclusion Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. [IMAGE = 99] denominator Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard ([ct = 99] AND ([GTOTAL < 8] OR [GTOTAL = 99]) AND ([PSA 20] OR [PSA = ] OR [PSA = ])) OR ([GTOTAL = 99] AND [ct<> T3 or T3a or T3b or T3c or T4] AND ([PSA 20] OR [PSA = ] OR [PSA = ])) OR ([PSA = ] AND [ct <> T3 or T3a or T3b or T3c or T4] AND ([GTOTAL < 8] OR [GTOTAL = 99])) OR ([TYPESURG = 99] AND [RADIO <> 3] AND [BRACHYDATE = 10/10/1010]) OR ([RADIO = 99] AND [TYPESURG <> 1] AND [BRACHYDATE = 10/10/1010])

8 QPI 3: Pathology Reporting QPI Title: All surgical pathology reports for prostate needle biopsies should contain full pathology information to inform treatment decision making. Description: Numerator Proportion of patients who undergo needle biopsy where the pathology report contains a full set of data items (as defined by the Scottish Urological Pathologists dataset see appendix 4 of QPI document). Number of patients with prostate adenocarcinoma who undergo prostate needle biopsy where needle biopsy pathology report contains all data items (as defined in the Scottish Urological Pathologists dataset see appendix 4 of QPI document). Type of Specimen for Histological Diagnosis (Prostate Cancer) not coded as Not Recorded; AND Number of Needle Cores Received (Right- Left) not coded as Not Recorded; AND Transurethral Resection of Prostate (TURP) Weight not coded as Not Recorded; AND Prostate Specimen Tumour Type not coded as Not Recorded; AND Number of Needle Cores Involved (Right-Left) not coded as Not Recorded; AND Total Percentage of Tumour Involvement in Needle Core OR Greatest Percentage of Tumour Involvement in Needle Core not coded as Not Recorded; AND Adipose Tissue Invasion Seen not coded as Not Recorded; AND Perineural Invasion Seen not coded as Not Recorded; AND Primary Gleason Grade (Needle Biopsy) not coded as Not Recorded; AND Secondary Gleason Grade (Needle Biopsy) not coded as Not Recorded; AND Gleason Total Score (Needle Biopsy) not coded as Not Recorded. [SPECTYPE <> 99] AND [NUMCORESRECR <> 99] AND [NUMCORESRECL <> 99] AND [TURPWT <> ] AND [TUMTYPE <> 99] AND [NUMCORESINVR <> 99] AND [NUMCORESINVL <> 99] AND ( [TOTPERCINV OR GRTPERCINV <> 999] ) AND [ADIPOSE <> 99] AND [PERINEURAL <> 99] AND [MAJGGRADE <> 99] AND [MINGGRADE <> 99] AND [GTOTAL <> 99] Denominator All patients with prostate adenocarcinoma who undergo prostate needle biopsy (No exclusions). Date of Diagnosis in range specified for comparative analysis AND Type of Specimen for Histological Diagnosis (Prostate Cancer) coded as: Transrectal Ultrasound Guided Biopsy OR Transrectal Ultrasound Guided Biopsy (mpmri fusion biopsy) [SPECTYPE = 1 OR 3] numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target N/A (patients not recorded for the numerator are included in the numerator not met category for this standard) exclusion Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. N/A denominator Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [SPECTYPE = 99]

9 QPI 4: Multi-Disciplinary Team Meeting (MDT) QPI Title: Patients should be discussed by a multi-disciplinary team prior to definitive treatment. Description: Proportion of patients with prostate cancer who are discussed at MDT meeting before definitive treatment. Please note: The specifications of this QPI are separated to ensure clear measurement of patients with: (i) Non-metastatic prostate cancer (TanyNanyM0); and (ii) Metastatic prostate cancer (TanyNanyM1). Numerator (i) Number of patients with non-metastatic prostate cancer (TanyNanyM0) discussed at the MDT before definitive treatment. Date Discussed by Care Team (MDT) not coded as not applicable AND Date Discussed by Care Team (MDT) less than or equal to Date of Definitive Treatment OR Date of Definitive Treatment Equal to not applicable [MDTDATE <> 10/10/1010] AND ([MDTDATE DEFTREATDATE] OR [DEFTREATDATE = 10/10/1010]) Denominator (i) All patients with non-metastatic prostate cancer (TanyNanyM0) (Excluding patients who died before first treatment). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND TNM Metastases Classification (Clinical) (Cancer of the Prostate) coded as: No distant metastasis AND Type of First Cancer Treatment not coded as Patient Died Before Treatment; [cm = M0 ] AND [FIRSTTREATMODE <> 14]; Numerator (ii) Number of patients with metastatic prostate cancer (TanyNanyM1) discussed at the MDT within 4 weeks of commencing treatment. Date Discussed by Care Team (MDT) not coded as not applicable; AND Date Discussed by Care Team (MDT) minus Date of Definitive Treatment less than or equal to 28 days; OR Date of Definitive Treatment Equal to not applicable [MDTDATE <> 10/10/1010] AND ([MDTDATE DEFTREATDATE 28 days] OR [DEFTREATDATE = 10/10/1010]) Denominator (ii) All patients with metastatic prostate cancer (TanyNanyM1) (Excluding patients who died before first treatment). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND TNM Metastases Classification (Clinical) (Cancer of the Prostate) coded as: Distant metastasis; OR Non-regional lymph node(s); OR Bone(s); OR Other site(s); AND Type of First Cancer Treatment not coded as Patient Died Before Treatment; [cm = M1 OR M1a OR M1b OR M1c] AND [FIRSTTREATMODE <> 14]; numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [MDTDATE = 09/09/0909] OR [DEFTREATDATE = 09/09/0909]

10 exclusion Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. [FIRSTTREATMODE = 99] denominator Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [cm = 99]

11 QPI 5: Surgical Margins QPI Title: Organ confined prostate cancers which are surgically treated with radical prostatectomy should be completely excised. Description: Numerator Proportion of patients with pathologically confirmed, organ confined (stage pt2) prostate cancer who undergo radical prostatectomy in which tumour is present at the margin, i.e. positive surgical margin. Number of patients with stage pt2 prostate cancer who underwent radical prostatectomy in which tumour is present at the margin. Margin Status (Prostatectomy) coded as: Positive [MARGIN = 1] Denominator All patients with stage pt2 prostate cancer who underwent radical prostatectomy (No exclusions). Date of Diagnosis in range specified for comparative analysis, AND TNM Tumour Classification (Pathological) (Prostate) coded as: Tumour confined within the prostate; OR Tumour involves one half of one lobe or less; OR Tumour involves more than half of one lobe but not both lobes; OR Tumour involves both lobes, AND Definitive Operative Procedure coded as: Radical prostatectomy [pt= pt2 OR pt2a OR pt2b OR pt2c] AND [OPCODE = M61.1] numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [MARGIN = 99] exclusion Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. N/A denominator Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [pt = 99] OR [OPCODE = 99]

12 QPI 6: Volume of Cases Per Surgeon QPI Title: Description: Specification Surgery should be performed by surgeons who perform the procedure routinely. Number of radical prostatectomy procedures performed by a surgeon over a 1 year period. Number of radical prostatectomies performed by each surgeon in a given year (No exclusions). Number of operations (MainOp or Op1 or Op2 or Op3 = {M611 or M612 or M613 or M614 or M619}) perfomed by each surgeon where operation date is within time period specified. NB: If clinician responsible for relevant operation is not recorded, consultant/hcp responsible for care is used instead and this should be noted. It is recommended that where two consultants operate together on the same patient the case should be counted under the Lead Surgeon.

13 QPI 7: Hormone Therapy and Docetaxel Chemotherapy QPI Title: Patients with metastatic prostate cancer should undergo immediate hormone therapy, and chemotherapy where appropriate **. Description: Proportion of patients with metastatic prostate cancer (TanyNanyM1) who undergo immediate management with hormone therapy, and docetaxel chemotherapy. Please note: The specifications of this QPI are separated to ensure clear measurement of patients who receive: (i) (ii) Immediate hormone therapy; and Immediate hormone therapy and docetaxel chemotherapy. Numerator (i) Number of patients presenting with metastatic prostate cancer (TanyNanyM1) treated with immediate hormone therapy. Date Treatment Started (Hormone Therapy) minus Date Discussed by Care Team is less than or equal to 31 days, AND Hormonal Therapy Agent coded as: Gonadorelin Agonist (GnRH), or Gonadorelin Antagonist or Orchidectomy or Maximum Androgen Blockade (MAB). [HORMDATE - MDTDATE 31 days] AND [HORMAGENT = 1 OR 2 OR 7 OR 10] Denominator (i) All patients presenting with metastatic prostate cancer (TanyNanyM1). (Excluding patients documented to have refused immediate hormone therapy, and patients enrolled in clinical trials). Date of Diagnosis in range specified for comparative analysis, AND TNM Metastases Classification (Clinical) (Cancer of the Prostate) coded as: Distant metastasis; OR Non-regional lymph node(s); OR Bone(s); OR Other site(s), AND Type of Hormone Therapy not coded as: Patient refused AND Patient Entered into Clinical Trial {Prostate Cancer} not coded as: Yes. [cm = M1 OR M1a OR M1b OR M1c] AND [HORMTYPE <> 95] AND [TRIAL <> 1] Numerator (ii) Number of patients presenting with metastatic prostate cancer (TanyNanyM1) treated with immediate hormone therapy and docetaxel chemotherapy. Date Treatment Started (Hormone Therapy) minus Date Discussed by Care Team is less than or equal to 31 days, AND Hormonal Therapy Agent coded as: Gonadorelin Agonist (GnRH) or Gonadorelin Antagonist or Orchidectomy or Maximum Androgen Blockade (MAB), AND Chemotherapy Agent coded as: docetaxel chemotherapy AND Date Treatment Started (Chemotherapy) minus Date Treatment Started (Hormone Therapy) is less than or equal to 90 days. [HORMDATE - MDTDATE 31 days] AND [HORMAGENT = 1 OR 2 OR 7 OR 10] AND [CHEMAGENT = 1] AND [CHEMDATE HORMDATE 90 days] Immediate hormone therapy would be within 31 days of MDT meeting (pre-treatment). LHRH agonist / antagonist monotherapy, dual androgen blockade or bilateral orchidectomy. ** Docetaxel should be started within 90 days of first dose of hormone therapy.

14 Denominator (ii) All patients presenting with metastatic prostate cancer (TanyNanyM1). (Excluding patients documented to have refused immediate hormone therapy, patients documented to have refused chemotherapy and patients enrolled in clinical trials). Date of Diagnosis in range specified for comparative analysis, AND TNM Metastases Classification (Clinical) (Cancer of the Prostate) coded as: Distant metastasis; OR Non-regional lymph node(s); OR Bone(s); OR Other site(s), AND Type of Hormone Therapy not coded as: Patient refused AND Chemotherapy Agent not coded as: Patient refused AND Patient Entered into Clinical Trial {Prostate Cancer} not coded as: Yes. [cm = M1 OR M1a OR M1b OR M1c] AND [HORMTYPE <> 95] AND [CHEMAGENT <> 95] AND [TRIAL <> 1] numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target (i) [HORMDATE = 09/09/0909] OR [MDTDATE =09/09/0909] OR [HORMAGENT = 99] (ii) [HORMDATE = 09/09/0909] OR [MDTDATE =09/09/0909] OR [HORMAGENT = 99] OR [CHEMAGENT = 99] OR [CHEMDATE = 09/09/0909] exclusion Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. (i) [HORMTYPE = 99] OR [TRIAL = 99] (ii) [HORMTYPE = 99] OR [CHEMAGENT = 99] OR [TRIAL = 99] denominator Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [cm = 99]

15 QPI 8: Post Surgical Incontinence QPI Title: Post surgical incontinence for patients with prostate cancer should be minimised. Description: Proportion of prostate cancer patients who undergo radical prostatectomy with post surgical incontinence approximately 1 year (between 10 and 14 months) after surgery. Numerator (i) Number of patients with prostate cancer undergoing radical prostatectomy with post surgical incontinence (> 0 pads per day measured using a validated tool**) at 1 year (10-14 months) post radical prostatectomy. Post-Surgical Continence at One Year coded as: 1 pad/day; OR 2 pads/day [CONTINENT = 2 OR 3 ] Numerator (ii) Number of patients with prostate cancer undergoing radical prostatectomy with post surgical incontinence (greater than 1 pad per day measured using a validated tool) at 1 year (10-14 months) post radical prostatectomy. Post-Surgical Continence at One Year coded as 2pads/day [CONTINENT = 3 ] Denominator All patients with prostate cancer undergoing radical prostatectomy. (Excluding patients who undergo salvage prostatectomy and patients who receive adjuvant radiotherapy within 12 months of surgery). Date of Diagnosis in range specified for comparative analysis, AND Definitive Operative Procedure coded as: Radical prostatectomy, AND Type of Surgery NOT coded as: Salvage Surgery, AND External Beam Radiotherapy Course Type NOT coded as: Adjuvant AND Date Treatment Completed (External Beam Radiotherapy) minus Date of Definitive Surgery NOT within 12 months (365 days) [OPCODE = M61.1] AND [TYPESURG <> 3] AND NOT ( [RADIO = 2] AND [RCOMPDATE - SURGDATE < 365] ) numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [CONTINENT = 99] exclusion Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. [TYPESURG = 99] OR [RADIO = 99] OR [RCOMPDATE = 09/09/0909] OR [SURGDATE = 09/09/0909] denominator Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [OPCODE = 99]

16 QPI 11: Early Management of Active Surveillance QPI Title: Description: Men under active surveillance for prostate cancer should undergo appropriate investigations at the clinically relevant timings. Proportion of men with prostate cancer under active surveillance who undergo multiparametric MRI within 6 months, and prostate re-biopsy within 14 months of diagnosis. Please note: The specifications of this QPI are separated to ensure clear measurement of patients who have undergone: (i) (ii) Multiparametric MRI within 6 months of diagnosis; and Prostate re-biopsy within 14 months of diagnosis. Numerator (i) Number of patients with prostate cancer under active surveillance who undergo multiparametric MRI within 6 months of diagnosis. Date of Multiparametric MRI Scan (Surveillance) minus Date of Diagnosis is less than or equal to 182 days [MPDATESURV DIAGDATE 182 days] Denominator (i) All patients with prostate cancer under active surveillance (Excluding patients unable to undergo an MRI scan and patients who refuse MRI). Date of Diagnosis in range specified for comparative analysis, AND Type of First Cancer Treatment coded as: Active Surveillance AND Multiparametric MRI Scan (Surveillance) not coded as: Patient unable to undergo MRI scan or Patient refused MRI. [FIRSTTREATMODE = 12] AND [MPMRISURV <> 3 OR 95] Numerator (ii) Number of patients with prostate cancer under active surveillance who undergo transrectal ultrasound guided (TRUS) prostate re-biopsy within 14 months of diagnosis. Date of TRUS Re-Biopsy minus Date of Diagnosis is less than or equal to 427 days [REBIODATE DIAGDATE 427 days] Denominator (ii) All patients with prostate cancer under active surveillance (Excluding patients who undergo radical treatment within 14 months of diagnosis and patients who refuse biopsy). Date of Diagnosis in range specified for comparative analysis, AND Type of First Cancer Treatment coded as: Active Surveillance AND Trus Re-biopsy is not coded as Patient has undergone radical treatment or Patient refused biopsy. [FIRSTTREATMODE = 12] AND [REBIOPSY <> 3 or 95]

17 numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target (i) [MPDATESURV = 09/09/0909] OR [DIAGDATE = 09/09/0909] (ii) [REBIODATE = 09/09/0909] OR [DIAGDATE = 09/09/0909] exclusion Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. (i) [MPMRISURV = 99] (ii) [REBIOPSY = 99] denominator Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard (i) and (ii) [FIRSTTREATMODE = 99]

18 QPI 12: 30 Day Mortality following Chemotherapy QPI Title: Description: 30 day mortality following chemotherapy treatment for prostate cancer. Proportion of patients with prostate cancer who die within 30 days of chemotherapy. Numerator: Number of patients with prostate cancer who undergo chemotherapy that die within 30 days of treatment. Date of Death is not coded as inapplicable and is within 30 days of date of the first day of the last cycle of chemotherapy [DOD - CHEMENDATE 30]) AND [DOD <> 10/10/1010] Denominator: All patients with prostate cancer who undergo chemotherapy (No exclusions). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Chemotherapy Agent (Prostate Cancer) is coded as Docetaxel or Other [CHEMAGENT = 1 or 2] Not recorded for numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [CHEMENDATE = 09/09/0909] OR [DOD = 09/09/0909] Not recorded for exclusion Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. N/A Not recorded for denominator Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [CHEMAGENT = 99]