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BMJ Open. 2018 Oct 24;8(10):e024941. doi: 10.1136/bmjopen-2018-024941.

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.

Author information

1
Division of Surgery and Interventional Science, University College London, London, UK.
2
Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
3
Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK.
4
Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK.
5
Division of Medicine, Centre for Medical Imaging, University College London, London, UK.
6
Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
7
Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.

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.

KEYWORDS:

local anaesthetic; prostate cancer diagnostic pathway; targeted prostate biopsy; transperineal prostate biopsy

Conflict of interest statement

Competing interests: HUA’s research is supported by core funding from the UK’s National Institute of Health Research (NIHR) Imperial Biomedical Research Centre. This paper is independent research funded by the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC). HUA currently receives funding from the Wellcome Trust, Prostate Cancer UK, Sonacare Inc, Trod Medical and Sophiris Biocorp for trials in prostate cancer. HUA is a paid medical consultant for Sophiris Biocorp for trials work. ME’s research is supported by core funding from the UK’s National Institute of Health Research (NIHR) UCLH/UCL Biomedical Research Centre. He was awarded NIHR Senior Investigator in 2015. ME receives funding from NIHR-i4i, MRC, Sonacare Inc, Trod Medical, Cancer Vaccine Institute and Sophiris Biocorp for trials in prostate cancer. ME is a medical consultant to Sonacare Inc, Sophiris Biocorp, Steba Biotech, Exact Imaging and Profound Medical. CMM receives funding from the National Institute for Health Research, The European Association of Urology Research Foundation, Prostate Cancer UK, Movember and the Cancer Vaccine Institute, for clinical prostate cancer research. She has received advisory board fees for Genomic Health. HUA, ME, and CMM are all proctors for HIFU and are paid for training other surgeons in this procedure. ME and AF have loan notes/stock options in Nuada Medical Ltd (UK).

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