Defining the need for prostate cancer radiotherapy in the general population: a criterion-based benchmarking approach.

AIMS: Determining the appropriate rate of radiotherapy is important for ensuring optimal radiotherapy utilisation and accessibility. A criterion-based benchmark (CBB) approach was developed as an alternative to evidence-based methods of determining the need for radiotherapy in prostate cancer. Our primary objective was to determine the initial/lifetime CBB radiotherapy rates in prostate cancer and to compare results with evidence-based estimates. Secondary objectives were to compare observed radiotherapy rates in Ontario, Canada and the USA with the estimated rates.
MATERIALS AND METHODS: Benchmarks were defined in Ontario as communities in proximity to cancer centres and without long waiting lists. Surgical and radiotherapy data, encompassing both external beam radiation and brachytherapy, for 1997-2001 were collected for Ontario cancer patients. The Surveillance, Epidemiology and End Results (SEER) public use file described treatment in the USA.
RESULTS: In total, 35 379 cases of prostate cancer were diagnosed in Ontario and 93 275 in SEER. CBB estimates of the initial/lifetime need for radiotherapy were 37.2% (95% confidence interval: 35.8-38.7) and 59.1% (54.3-63.9). Our group's evidence-based estimate (Ebest) rates were 32.3% (28.5-36.1) and 61.2% (55.6-66.8). Observed initial radiotherapy rates were 28.0% (27.5-28.4) in Ontario and 37.0% (36.7-37.3) in SEER. In Ontario, the estimated lifetime rate was 42.6% (41.2-44.0).
CONCLUSIONS: CBB provides a reasonable estimate of the need for radiotherapy in prostate cancer. Observed initial radiotherapy rates in the USA were concordant with the CBB estimate. The CBB suggests a shortfall in radiotherapy utilisation for prostate cancer in Ontario.