Leveraging the Electronic Medical Record Improves Prostate Cancer Clinical Staging in a Community Urology Practice

Introduction: Clinical tumor staging is an important component of risk stratification, which is central in assessment and treatment of patients with prostate cancer. We evaluated the potential of an examination based tumor staging template embedded within the electronic medical record to improve consistency and clarity of clinical tumor staging.

Methods: We conducted a retrospective analysis before template implementation (January to March 2017), followed by prospective analysis after implementation (April to August 2017). Physicians were educated on use and importance of the staging template prior to implementation. Assessment of digital rectal examination clarity included confident-explicit (cT stage documented), confident-implicit (stage inexplicit, cT stage interpreted) and unconfident (inability to discern cT stage). Clarity and consistency of tumor staging before and after template implementation were compared using a chi-square test.

Results: A total of 573 biopsies were analyzed: 234 before template use (40%) and 339 after (60%). In men at risk for prostate cancer explicit staging increased from 16% to 60% (p <0.001) following implementation of the staging template. Overall staging (explicit plus implicit) increased (from 74% to 92%, p <0.001), while unconfident staging decreased (from 26% to 8%, p <0.001) after implementation. In men with positive biopsies (309) explicit staging increased (from 29% to 64%, p <0.001) and overall staging increased (from 76% to 92%, p <0.001), while unconfident staging decreased (from 24% to 8%, p <0.001).

Conclusions: Accurate prostate cancer clinical staging is important in risk stratification and treatment. We demonstrate the ability of a standardized, electronic medical record embedded, American Joint Committee on Cancer based template to improve the consistency and clarity of clinical staging in prostate cancer.