Effect of a tumor staging template on consistency and clarity of prostate cancer staging.

Abstract

35 Background: Risk stratification (RS) is central in assessment and treatment of Prostate cancer (PCa). Accurate clinical staging (cT-Stage) based on AJCC criteria is a key component of RS and certain quality measures (PQRS #102). We assessed the potential of a tumor staging template (TST) embedded into an electronic medical record (EMR) to improve consistency and clarity of clinical tumor staging based on digital rectal examination (DRE) near the time of prostate needle biopsy (PNB). Methods: Retrospective analysis before TST implementation followed by prospective analysis after implementation of the TST was performed at Genesis Health Care Partners. Study period was January 1, 2017 through August 23, 2017. TST was implemented into the EMR and physicians were trained in its use on April 1, 2017. CT-Stage was independently categorized based on physicians’ notations. Descriptions of DRE included; confident-explicit (CE) (cT-Stage documented), confident-implicit (CI) (cT-Stage not documented, DRE amply detailed to interpret cT-Stage), and unconfident- inability to discern T-stage (UI). Classification categories prior to and after TST implementation were compared and analyzed using a chi-square test. Two cohorts were evaluated; men at risk for PCa undergoing PNB, and men with diagnosed PCa. Results: 573 PNBs were analyzed: 234/573 before TST (40.2%) and 339/573 after TST (59.8%). 305/573 (53.2%) PNBs were positive for PCa: 118 before TST and 187 after TST. In men at risk of PCa, CE staging increased from 15.8% to 57.8% (p < 0.001) after TST use. Overall staging (CE+CI) increased from 73.5% to 89.1% (p < 0.001), while UI staging decreased from 26.5% to 10.9% (p < 0.001) after TST use. In men with positive PNBs, CE staging increased from 28.8% to 62.6% (p < 0.001) after TST use. Overall staging (CE+CI) increased from 75.4% to 88.8% (p = 0.004), while UI staging decreased from 24.6% to 11.2% (p = 0.003) after TST use. Conclusions: In an era of precision-oriented medicine, accurate clinical tumor assessment, description, and staging is of great importance in RS and treatment recommendation. Our study demonstrates the ability of a standardized EMR-embedded, AJCC based template to improve the consistency and clarity of clinical staging of PCa.