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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

Bass, EJ; Freeman, A; Jameson, C; Punwani, S; Moore, CM; Arya, M; Emberton, M; (2018) 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. BMJ Open , 8 (10) , Article e024941. 10.1136/bmjopen-2018-024941. Green open access

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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.

Type: Article
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
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmjopen-2018-024941
Publisher version: https://doi.org/10.1136/bmjopen-2018-024941
Language: English
Additional information: 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: local anaesthetic, prostate cancer diagnostic pathway, targeted prostate biopsy, transperineal prostate biopsy
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Department of Imaging
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: https://discovery.ucl.ac.uk/id/eprint/10060246
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