title: Estimation of the optimal utilisation rates of radical prostatectomy, external beam radiotherapy and brachytherapy in the treatment of prostate cancer by a review of clinical practice guidelines.
abstract: OBJECTIVE
  We aimed to construct an evidence-based model of optimal treatment utilisation for prostate cancer, incorporating all local treatment modalities: radical prostatectomy (RP), external beam radiotherapy (EBRT), and brachytherapy (BT); and then to compare this optimal model with actual practice.
  
  
  METHODS
  Evidence-based guidelines were used to construct a prostate cancer treatment decision-tree. The proportion of patients who fulfilled treatment criteria was drawn from the epidemiological literature. These data were combined to calculate the overall proportion of patients that should optimally have RP, EBRT and/or BT at least once during the course of their disease. The model was peer reviewed and tested by sensitivity analyses and compared with actual practice.
  
  
  RESULTS
  Optimal utilisation rates, at some point during the disease course, were: RP, 24% (range 15-30%); EBRT, 58% (range 54-64%); BT, 9.6% (range 6.0-17.9%); and any RT, 60% (range 56-66%). Many patients had indications for more than one of these treatments, and at least one of these treatments was indicated in 76% of patients. The model was sensitive to patient preference estimates. Optimal rates were achievable in some health care jurisdictions.
  
  
  CONCLUSIONS
  Modelling optimal utilisation of all local treatment options for a particular cancer is possible. These optimal prostate cancer treatment rates can be used as a planning and quality assurance tool, providing an evidence-based benchmark against which can be measured patterns of practice.
authors.affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool Hospital, UNSW, Sydney, Australia; Department of Radiation Oncology, Prince of Wales Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia. Electronic address: stephen.thompson@sesiahs.health.nsw.gov.au.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Thompson
authors.affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool Hospital, UNSW, Sydney, Australia; University of New South Wales, Sydney, Australia; University of Western Sydney, Australia.
authors.forename: Geoff P
authors.initials: GP
authors.lastname: Delaney
authors.affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool Hospital, UNSW, Sydney, Australia; University of New South Wales, Sydney, Australia.
authors.forename: Susannah
authors.initials: S
authors.lastname: Jacob
authors.affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool Hospital, UNSW, Sydney, Australia; University of New South Wales, Sydney, Australia.
authors.forename: Jesmin
authors.initials: J
authors.lastname: Shafiq
authors.affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool Hospital, UNSW, Sydney, Australia; University of New South Wales, Sydney, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Wong
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Hanna
authors.affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool Hospital, UNSW, Sydney, Australia; University of New South Wales, Sydney, Australia.
authors.forename: Gabriel S
authors.initials: GS
authors.lastname: Gabriel
authors.affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool Hospital, UNSW, Sydney, Australia; University of New South Wales, Sydney, Australia.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Barton
mesh_terms: D001918:Brachytherapy / Q000706:statistics & numerical data*; D018450:Disease Progression; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011468:Prostatectomy / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D012044:Regression Analysis
keywords: Brachytherapy; Patterns of care; Prostate cancer; Radical prostatectomy; Radiotherapy; Utilisation rate