Rapid Access Prostate Imaging and Diagnosis (RAPID) pathway – an innovative approach for prostate cancer diagnosis
BAUS ePoster online library. Eldred-evans D. 06/24/19; 259539; P5-1
David Eldred-evans
David Eldred-evans
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INTRODUCTION: The incentive to provide a rapid and streamlined diagnostic approach for suspected cancer is growing. We report the outcomes of a new 'one-stop' Rapid Access Prostate Imaging and Diagnosis (RAPID) pathway introduced across three hospitals. This pathway streamlines the standard diagnostic pathway into a single visit using MRI-triage and if required same-day transperineal targeted and systematic biopsy.

Patients and Methods:

837 patients were referred into the RAPID pathway between April 2017 and October 2018. Patients received an appointment for mpMRI and clinical review on the same day. A transperineal prostate biopsy (TP-Bx) was offered on the same day if the mpMRI score was 4 or 5. A score of 3 required a PSA density >/=0.12.

The mean age 65.3 (59.3 - 71.6). mean PSA 9.0 (5.1–9.8) and mean time from referral to mpMRI +/- biopsy was 10.3 (7-13) days. 325 (38.8%) patients had a non-suspicious mpMRI and did not require TP-Bx. Out of the 383 proceeding to TP-Bx with a positive MRI, 68% were diagnosed with prostate cancer and 81% of those had clinically significant disease. Of the patients with a negative biopsy, 52% had known causes of MRI false-positives (inflammation/atrophy). There was a 0.2% risk of urosepsis.

Conclusions : RAPID is a safe and effective pathway for diagnosis of suspected prostate cancer that shortens the interval from referral to diagnosis. Our MRI-triage approach allows 1 in 3 men to avoid an immediate biopsy whilst 8 in 10 men with cancer on biopsy had clinically significant disease.
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