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Prostate cancer diagnostic pathway: Is a one-stop cognitive MRI targeted biopsy service a realistic goal in everyday practice? A pilot cohort in a tertiary referral centre in the UK

Title: Prostate cancer diagnostic pathway: Is a one-stop cognitive MRI targeted biopsy service a realistic goal in everyday practice? A pilot cohort in a tertiary referral centre in the UK
Authors: Bass, EJ
Freeman, A
Jameson, C
Punwani, S
Moore, CM
Arya, M
Emberton, M
Ahmed, HU
Item Type: Journal Article
Abstract: Objectives To evaluate the feasibility of a novel multiparametric MRI (mpMRI) and cognitive fusion transperineal targeted biopsy (MRTB) led prostate cancer (PCa) diagnostic service with regard to cancer detection and reducing time to diagnosis and treatment. Design Consecutive men being investigated for possible PCa under the UK 2-week wait guidelines. Setting Tertiary referral centre for PCa in the UK. Participants Men referred with a raised prostate-specific antigen (PSA) or abnormal digital rectal examination between February 2015 and March 2016 under the UK 2-week rule guideline. Interventions An mpMRI was performed prior to patients attending clinic, on the same day. If required, MRTB was offered. Results were available within 48 hours and discussed at a specialist multidisciplinary team meeting. Patients returned for counselling within 7 days Primary and secondary outcome measures Outcome measures in this regard included the time to diagnosis and treatment of patients referred with a suspicion of PCa. Quality control outcome measures included clinically significant and total cancer detection rates. Results 112 men were referred to the service. 111 (99.1%) underwent mpMRI. Median PSA was 9.4 ng/mL (IQR 5.6–21.0). 87 patients had a target on mpMRI with 25 scoring Likert 3/5 for likelihood of disease, 26 4/5 and 36 5/5. 57 (51%) patients received a local anaesthetic, Magnetic resonance imaging targeted biopsy (MRTB). Cancer was detected in 45 (79%). 43 (96%) had University College London definition 2 disease or greater. The times to diagnosis and treatment were a median of 8 and 20 days, respectively. Conclusions This approach greatly reduces the time to diagnosis and treatment. Detection rates of significant cancer are high. Similar services may be valuable to patients with a potential diagnosis of PCa.
Issue Date: 1-Oct-2018
Date of Acceptance: 20-Sep-2018
URI: http://hdl.handle.net/10044/1/68153
DOI: https://dx.doi.org/10.1136/bmjopen-2018-024941
ISSN: 2044-6055
Publisher: BMJ Journals
Journal / Book Title: BMJ Open
Volume: 8
Issue: 10
Copyright Statement: © 2018 The Author(s). This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
ULTRASOUND-GUIDED BIOPSY
MULTIPARAMETRIC MRI
COST-EFFECTIVENESS
RESONANCE
FUSION
ACCURACY
RECOMMENDATIONS
COMPLICATIONS
GUIDELINES
RISK
local anaesthetic
prostate cancer diagnostic pathway
targeted prostate biopsy
transperineal prostate biopsy
Publication Status: Published
Article Number: e024941
Online Publication Date: 2018-10-24
Appears in Collections:Division of Surgery
Faculty of Medicine



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