PRostate cancer Awareness and Initiative for Screening Europe (PRAISE-U) is a project testing organized, risk-stratified prostate cancer screening. Micro-, meso-, and macrolevel stakeholders involved in PRAISE-U are participating in collaborative user boards. These stakeholders have identified themes including men's health beliefs, accessibility of screening, and considerations for success.

Background:Monitoring and evaluation of prostate cancer (PCa) screening is key to ensure that the programme achieves the desired objectives. Utilizing a set of prioritized, feasible and harmonized key performance indicators (KPIs) is crucial for this purpose. We describe the methodology used to identify the PCa screening KPIs and the outcome of this process within the scope of the EU-funded PRostate cancer Awareness and Initiative for Screening in the EU (PRAISE-U) project. Feasibility of implementing these KPIs will be evaluated in the five pilots set up at multiple sites in the EU (Spain-2 sites, Poland, Ireland, Lithuania). Methods:The indicators were developed following a structured methodology involving the following steps: (i) Development of a specific conceptual framework for PCa screening is adapted from the existing risk-based algorithms and modified to guide the selection and mapping of indicators (from identification of population eligible for screening to the decision for treatment or follow-up), (ii) Scoping review of literature (coverage from 1971 to June 2023) to identify existing performance indicators for PCa screening to adapt to the new framework with redefining the indicators, where necessary, (iii) Survey among experts (October-November 2023) to select the indicators fulfilling pre-determined criteria such as accuracy of definition and calculation, importance, and feasibility, and (iv) Deliberations among experts to list the finalized set of indicators, held in December 2023. Findings:A total of 63 KPIs were selected for review using the step-wise methodology as described earlier. Following the review, survey, and deliberations, 21 KPIs were finalized to be piloted in the PRAISE-U project. The resulting 21 KPIs cover the different phases of the screening programme, including invitation, screening test, risk stratification, diagnosis, and also on treatment, harms, and impact. Each KPI has been defined with agreed numerator and denominator. Interpretation:Continuous monitoring of PCa screening programmes using the KPIs will serve as a powerful tool for optimizing service delivery, programme improvement, comparison per screening site, and ultimately contributing to a better benefit to harm ratio. The KPIs will be implemented in five pilot sites identified to be included in the PRAISE-U project aiming to identify an evidence-based scalable model for risk adapted PCa screening for Europe. Funding:This project has received funding from the EU4Health program under grant agreement 101101217, co-funded by the European Union.

PurposeTo describe the Irish Prostate Cancer Outcomes Research (IPCOR) registry. The cohort was collected to inform and improve the prostate cancer journey of men in Ireland.ParticipantsEstablished in 2015, IPCOR was a unique large-scale prospective cohort study registering men with prostate cancer in Ireland. From 2016 to 2020, IPCOR collected data on 6816 men who were newly diagnosed with prostate cancer across 16 hospitals, both public and private. A comprehensive clinical dataset was collected, capturing detailed information on men’s diagnosis, treatments and follow-up. In addition, a subset of 873 men completed patient-reported outcome measures.Findings to dateThe IPCOR study has revealed several key insights into prostate cancer diagnosis and treatment in Ireland. The data indicate a high rate of diagnosis through opportunistic Prostate-Specific Antigen screening, with many cases identified at an early stage.Future plansIPCOR invites collaboration from the global cancer research community to use this resource to advance prostate cancer research and improve patient outcomes worldwide. IPCOR aims to continue updating long-term survival follow-up data for this cohort. It also plans to continue its collaborative approach with patients, engaging with the Lived Experience Advisory Panel in interpreting results emerging from this dataset. Moving forward, IPCOR is planning its next phase of the project, IPCOR 2.0. This will be a prospective, longitudinal, multi-centre clinical quality registry and biorepository.

INTRODUCTION:The Irish Prostate Cancer Outcomes Research (IPCOR) Study collected longitudinal data on men newly diagnosed with Prostate Cancer (PC). Understanding the nuances of disease presentation is essential, considering the high incidence of PC in Ireland. This study aims to characterise disease presentation features, identify factors related to socio demographic disparities in presentation following opportunistic screening, and shed light on potential inequality challenges within Ireland's healthcare structure. METHODS:Data were collected on demographics, diagnosis, and treatment of 6,816 men newly diagnosed with PC across 16 hospitals in the Republic of Ireland from February 2016 to January 2020. A complete case analysis was carried out, complemented by a sensitivity analysis for addressing sites with high rates of missing values. Multivariable logistic regression was conducted to examine the association between various predictor variables and the initial presentation to the urology clinic subsequent to opportunistic screening. RESULTS:A multivariable logistic regression model revealed that the type of hospital was a key determinant in post-opportunistic screening presentation, with patients in public hospitals 45.7% more likely to be presented following screening compared to those in private hospitals. Urban residents were 34% more likely to present following screening than rural ones. Age negatively influenced presentation following screening likelihood, decreasing by 3.4% yearly. DISCUSSION:Our research has highlighted the key features of PC presentation in Ireland, revealing potential inequalities affecting mainly urban populations, middle socioeconomic groups, and individuals with inadequate healthcare coverage. While the differences we observed in various groups may appear subtle and may indicate the success of the Rapid Access Prostate Clinics, they are still significant in pinpointing specific populations that require special attention. CONCLUSIONS:By addressing these nuanced differences in access to healthcare, socioeconomic status, and urban versus rural residence and implementing tailored strategies, we can work towards closing disparity gaps in PC, ultimately leading to improved health outcomes and equity across all population segments.

Prostate cancer (PCa) is a major public health concern for men globally and the most commonly diagnosed cancer among men in the European Union (EU). Despite large trials suggesting benefits from early detection of PCa, risks of overdiagnosis and overtreatment are evident. In 2022, the EU Commission proposed introducing prostate-specific antigen (PSA) testing for men in an organised setting, in combination with magnetic resonance imaging (MRI) scanning as a follow-up test to minimise these risks. PRostate cancer Awareness and Initiative for Screening Europe (PRAISE-U) is a pilot study evaluating the implementation of a risk-stratified population-based approach to PCa screening in Ireland, Lithuania, Poland, and two areas in Spain (Galicia and Manresa) for feasibility, efficacy, and cost effectiveness. As per the protocol designed for the pilots, men aged 50-69 yr residing within the catchment area of the study sites will be invited to participate. Those consenting to participate will undergo PSA testing, and men with PSA >3 ng/ml will undergo risk stratification before MRI and, if necessary, after MRI before undergoing biopsy. A collaborative user board comprising health care professionals, patients, and decision-makers will be formed to provide stakeholder input throughout the study. PRAISE-U will be evaluated on three major pillars: analysis of clinical and programme outcomes, psychosocial impact, and cost effectiveness. A set of key performance indicators (KPIs) has been developed to be piloted in the PRAISE-U pilot sites. The KPIs will serve to assess the performance and outcomes of risk-stratified PCa screening at each site. A REDCap database will be used to collect and manage pseudoanonymised data from the pilot sites. Ethics approval was obtained from each pilot site. The PRAISE-U pilot implementation is expected to commence in the 3rd quarter of 2024 for 12 mo and provide valuable data on the implementation outcomes of a risk-stratified screening approach across Europe. The findings is expected to inform the development of an optimised screening strategy with an acceptable benefit to harm ratio.

Informed choice approaches lead to high rates of unsystematic PSA testing, especially among those least likely to benefit and most likely to be harmed, argue Andrew Vickers and colleagues

BACKGROUND:The Movember funded TrueNTH Global Registry (TNGR) aims to improve care by collecting and analysing a consistent dataset to identify variation in disease management, benchmark care delivery in accordance with best practice guidelines and provide this information to those in a position to enact change. We discuss considerations of designing and implementing a quality of care report for TNGR. METHODS:Eleven working group sessions were held prior to and as reports were being built with representation from clinicians, data managers and investigators contributing to TNGR. The aim of the meetings was to understand current data display approaches, share literature review findings and ideas for innovative approaches. Preferred displays were evaluated with two surveys (survey 1: 5 clinicians and 5 non-clinicians, 83% response rate; survey 2: 17 clinicians and 18 non-clinicians, 93% response rate). RESULTS:Consensus on dashboard design and three data-display preferences were achieved. The dashboard comprised two performance summary charts; one summarising site's relative quality indicator (QI) performance and another to summarise data quality. Binary outcome QIs were presented as funnel plots. Patient-reported outcome measures of function score and the extent to which men were bothered by their symptoms were presented in bubble plots. Time series graphs were seen as providing important information to supplement funnel and bubble plots. R Markdown was selected as the software program principally because of its excellent analytic and graph display capacity, open source licensing model and the large global community sharing program code enhancements. CONCLUSIONS:International collaboration in creating and maintaining clinical quality registries has allowed benchmarking of process and outcome measures on a large scale. A registry report system was developed with stakeholder engagement to produce dynamic reports that provide user-specific feedback to 132 participating sites across 13 countries.

BACKGROUND:The development, monitoring, and reporting of indicator measures that describe standard of care provide the gold standard for assessing quality of care and patient outcomes. Although indicator measures have been reported, little evidence of their use in measuring and benchmarking performance is available. A standard set, defining numerator, denominator, and risk adjustments, will enable global benchmarking of quality of care. OBJECTIVE:To develop a set of indicators to enable assessment and reporting of quality of care for men with localised prostate cancer (PCa). DESIGN, SETTING, AND PARTICIPANTS:Candidate indicators were identified from the literature. An international panel was invited to participate in a modified Delphi process. Teleconferences were held before and after each voting round to provide instruction and to review results. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:Panellists were asked to rate each proposed indicator on a Likert scale of 1-9 in a two-round iterative process. Calculations required to report on the endorsed indicators were evaluated and modified to reflect the data capture of the Prostate Cancer Outcomes Registry-Australia and New Zealand (PCOR-ANZ). RESULTS AND LIMITATIONS:A total of 97 candidate indicators were identified, of which 12 were endorsed. The set includes indicators covering pre-, intra-, and post-treatment of PCa care, within the limits of the data captured by PCOR-ANZ. CONCLUSIONS:The 12 endorsed quality measures enable international benchmarking on the quality of care of men with localised PCa. Reporting on these indicators enhances safety and efficacy of treatment, reduces variation in care, and can improve patient outcomes. PATIENT SUMMARY:PCa has the highest incidence of all cancers in men. Early diagnosis and relatively high survival rates mean issues of quality of care and best possible health outcomes for patients are important. This paper identifies 12 important measurable quality indicators in PCa care.