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<v Neil deGrasse Tyson>Then I would like to introduce
the two persons who will

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<v Baby Huey>be doing the thing.

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<v Neil deGrasse Tyson>And it's first Hans Heinzer
from the University Medical

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<v Baby Huey>Center from Hamburg. Eppendorf.

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It's the Martini-Clinic
that Barbara mentioned.

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And after Hans. we
will hear Maha Hussain

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from University of Michigan.

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So. thank you very much
for the kind invitation

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to be here at ASCO.

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And in the next minute.
it's a privilege

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to share care. a case
with Dr. Hussain.

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So. I will take over more the
part of the localized prostate

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cancer. and Dr.
Hussain will take over

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the part of the
advanced disease.

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And I would like to
discuss with that case

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what could value-based care
mean to a certain patient

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in that field.

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So. let me start with
a short statistics.

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Like in the US.
the prostate cancer

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is one of the most
common cancer in men.

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And that statistic. that's
included 40 different countries

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of Europe.

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So in 2012. there were
more than 400.000 new cases

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of prostate cancer.

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And on the right side. you see
especially the German figures.

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So. this is of importance for
prostate cancer will further

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rise because the
demographic changes-- so. we

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have an older population--
and an increasing

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incidence of prostate cancer.

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So. that's really true
in Germany at that point.

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and even in most
countries in Europe.

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And we have an increasing
life expectancy.

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and the prostate cancer specific
survivability will improve.

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So what we do is we
put prostate cancer

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more to a chronic
disease at the moment.

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So. let me start with our case.

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It's a newly diagnosed
man with prostate cancer.

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He's 61 years old.

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He has a ECOG of zero.
mild hypertension.

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So. he was diagnosed
in June 2012.

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He was evaluated for
urinary symptoms.

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and they found out that
his PSA was up to 25.

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So consequently. they took a
biopsy and found a Gleason 4+5

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prostate cancer in 8 of 12
[? courses. ?] They put him

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on some images. and he has a
negative bone scan and a CT

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scan with absence of metastasis.

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So taken together. he is a
high-risk prostate carcinoma

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that was-- he ended up for the
evaluation of urinary symptoms.

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So for that patient. it's time
for the decision-making process

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concerning the
therapeutic option.

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So. but what matter
for the patients?

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So. as a summary. patient gives
still the highest priority

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to medical outcomes.
but still have no access

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to the right information.

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So a survey was done in
different European patients.

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and they were asked
what criteria has

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the highest importance for you.

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And to show. like here. the
vast majority of patients

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wrote out that medical
quality. meaning outcomes.

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have the highest priority.

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Other factors. like here.
traveling time to the hospital.

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is not as important as
quality for the patients.

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And on the other
hand. when you just

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look what data can be
found from the perspective

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of the patients. so
there's really hard

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to find for the patient
answers like this.

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where's the best
treatment I could achieve.

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So. that's the reality.

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So. our patient has
decision-making ready.

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and he vote for a
radical prostatectomy.

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He has radical prostatectomy.
and the final pathology shows

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pT3b prostate cancer.
Gleason was 4+5.

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He has negative lymph nodes.
but microscopic involvement

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of the lymph nodes.
and no involvement

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of the venous vessels.

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And he has a negative
surgical margin.

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So. from the question of
outcome for this patient.

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does it matter who
did the operation

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and where it was done.

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And the answer is yes.

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We have some data that variation
in prostate cancer outcomes

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have been observed based on
institutional and physician

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differences.

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I will show you later
on some more data on it.

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And what do we need?

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As you see on that case. a
value-based decision. how.

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when. and where to treat
men with prostate cancer.

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So. we know what we have to
look for for that patient.

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We know condition-specific
outcomes that

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really matter to the patient.

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That is. of course. disease
control. the answer I am cured.

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what are my chances.

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The complications of treatment.
especially in prostate cancer

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in local treatment.
urinary incontinence.

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urinary obstruction.
bowel irritation.

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and sexual function.

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And of course. we have to deal
with long-term quality of life.

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So. are there already
systematic outcome measurements

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to improve care quality
as we heard before?

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So if you look. it's really
hard to find some data

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like that in Europe.

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So. the exception
is always Norway.

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They have already a substantial
registry of cancer patient.

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So if you'd just
like to compare data.

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and if you ask what is the
percentage of incontinence

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following radical prostatectomy.
how is the sexual function.

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it's really hard to find data.

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You find in Germany-- when we
looked at the German situation.

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you could find some data from
a single center experience.

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like our data.

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And interestingly. the only data
you find for a broader hospital

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average in Germany
is some data which

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are provided by
insurance companies.

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So that's the
reality in Germany.

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And of course. it's unfair
to really compare that figure

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like I do it here.
because there's

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no really standard definition
what incontinence really means.

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and what is sexual dysfunction.

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So it's just like a
historical comparison.

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So. very important tool
to measure the outcome

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is patient-reported
outcome. so PROMs.

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And just to give you an
example from our view.

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we just started to send out
PROMs in the early '90s.

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And now. we have more
than 80.000 patients

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under follow-up.

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And what was very astonishing.
and even for us is notable.

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is that the patient really
liked to be followed up.

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So we have a complete
follow-up for more than 75%

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of our patients.

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But on the other
way. it's really

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logistical and
financial challenge

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to do that. because at
the moment in Germany.

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for instance. there is no
support from the health care

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carrier to do that.

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So. it's just done by
the hospital itself.

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So. coming back to the
question does volume matter?

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Yes. it did.

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So. I give you
two examples here.

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One is from an American group.
from Vickers and colleagues.

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And they show that the more
experience the patient is.

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the better is the outcome
in concern of biochemical

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relapse after radical
prostatectomy.

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And we saw even the same in
the frequency of incontinence

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in our group.

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So with the time and with the
experience of the surgeon.

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different surgeon.
the percentage

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of patients who have good
continence improved over time.

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So. it's really the thing that
volume matters in surgery.

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And there's growing
concerns that this is also

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true in radiotherapies.

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That's a paper just coming up
at the beginning of this year.

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And they could show
that. even in facilities

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which have a high
volume radiotherapy.

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there's a slight but
significant improved

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in overall survival for
patients who are treated

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in a high-volume center.

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So that seems to be even
the case for radiotherapy.

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So. the reality in
Germany. I'd just

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like to mention
it in very short.

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So. even in certified
prostate cancer center.

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the median number of radical
prostatectomy performed is 54.

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So. that's really not a
high volume in Germany.

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And there are only a few
centers who do much more.

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So. that's a reality
even in Germany.

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So. I would like to end up what
we already heard with ICHOM.

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So. that is a
nonprofit organization

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who try to bring up
a [? start ?] set

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to measure value-based outcome.

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And they really start to bring
together experts in the field.

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And a question was. what
should be documented

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before and after treatment.

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And they really
bring up-- and they

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published that last
year-- a minimal standard

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set for cross-disciplinary
outcome measurements.

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And that's identical for
all treatment options.

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including patients who opt
for active surveillance.

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So at that point. I
stop my presentation.

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and like to give
over to Dr. Hussain.

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Thank you so much.

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[APPLAUSE]

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Thank you. Hans. very much.