title: An audit of referral and treatment patterns of high-risk prostate cancer patients in Alberta.
abstract: BACKGROUND
  We aimed to determine the impact of clinical practice guidelines (CPG) on rates of radiation oncologist (RO) referral, androgen-deprivation therapy (ADT), radiation therapy (RT), and radical prostatectomy (RP) in patients with high-risk prostate cancer (HR-PCa).
  
  
  METHODS
  All men >18 years, diagnosed with PCa in 2005 and 2012 were identified from the Alberta Cancer Registry. Patient age, aggregated clinical risk group (ACRG) score, Gleason score (GS), pre-treatment prostate-specific antigen (PSA), RO referral, and treatment received were extracted from electronic medical records. Logistic regression modelling was used to examine associations between RO referral rates and relevant factors.
  
  
  RESULTS
  HR-PCa was diagnosed in 261 of 1792 patients in 2005 and 435 of 2148 in 2012. Median age and ACRG scores were similar in both years (p>0.05). The rate of patients with PSA >20 were 67% and 57% in 2005 and 2012, respectively (p=0.004). GS ≤6 was found in 13% vs. 5% of patients, GS 7 in 27% vs. 24%, and GS ≥8 in 59% vs. 71% in 2005 and 2012, respectively (p<0.001). In 2005, RO referral rate was 68% compared to 56% in 2012 (p=0.001), use of RT + ADT was 53% compared to 32% (p<0.001), and RP rate was 9% vs. 17% (p=0.002). On regression analysis, older age, 2012 year of diagnosis and higher PSA were associated with decreased RO referral rates (odds ratios [OR] 0.49, 95% confidence interval [CI] 0.39-0.61; OR 0.51, 95% CI 0.34-0.76; and OR 0.64, 95% CI 0.39-0.61), respectively [p<0.001]).
  
  
  CONCLUSIONS
  Since CPG creation in 2005, RO referral rates and ADT + RT use declined and RP rates increased, which demonstrates a need to improve adherence to CPG in the HR-PCa population.
authors.affiliation: Division of Radiation Oncology, University of Calgary and Tom Baker Cancer Centre, Calgary, AB, Canada; Albaha University, Albaha, Saudi Arabia.
authors.forename: Majed
authors.initials: M
authors.lastname: Alghamdi
authors.affiliation: Division of Radiation Oncology, University of Calgary and Tom Baker Cancer Centre, Calgary, AB, Canada.
authors.forename: Amandeep
authors.initials: A
authors.lastname: Taggar
authors.affiliation: CancerControl, Alberta Health Services, Calgary, AB, Canada.
authors.forename: Derek
authors.initials: D
authors.lastname: Tilley
authors.affiliation: Division of Radiation Oncology, University of Calgary and Tom Baker Cancer Centre, Calgary, AB, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Kerba
authors.affiliation: CancerControl, Alberta Health Services, Calgary, AB, Canada.
authors.forename: Xanthoula
authors.initials: X
authors.lastname: Kostaras
authors.affiliation: Division of Urology, University of Calgary, Calgary, AB, Canada.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Gotto
authors.affiliation: Division of Radiation Oncology, University of Calgary and Tom Baker Cancer Centre, Calgary, AB, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Sia