Introduction and Objectives
In the UK patients presenting to Primary Care with suspected prostate cancer (PCa) are referred to Secondary Care within 2 weeks for specialist review.
Our Trust adopts a one-stop clinic (OSC) for assessing these referrals. OSC clinics employ a Urologist and nurse, with facilities to perform on-the-day transrectal US-guided (TRUS) prostate biopsy.
The Urologist evaluates each patient, deciding whether to refer for MRI, perform upfront TRUS biopsy or discharge.
NICE 2019 Guideline recommends MRI as initial diagnostic tool for suspected PCa has obviated need for many upfront biopsies, implying patients could be initially assessed in a standard outpatient appointment (OP) without costly TRUS facilities.
This study assesses the OSC’s utilisation of TRUS facilities and our Trust’s MRI accuracy, to extrapolate potential financial savings and ultimately re-design the PCa assessment pathway.
Material & Methods
All patients seen our Trust’s OSC between 1/11/18 and 1/4/19 were included.
Clinician plan and eventual diagnosis via TRUS biopsy and/or MRI were obtained from electronic records.
Tariffs were obtained from the Finance Department.
Results
501 consultations took place and 52 patients were diagnosed with PCa.
77 TRUS biopsies were performed – 42 on second visit after MRI (54%) and 35 upfront (45%) (6.9% of all patients).
Of 42 patients with prior MRI, 34 had a positive result (PIRADS 3-5) and 8 negative (PIRADS 1-2)
24/34 (71%) with positive MRI were confirmed to have PCa on TRUS biopsy. 3/8 patients with negative MRI were confirmed to have PCa (7.1% of all MRIs) (2 Gleason 7, 1 Gleason-6).
25/35 (71%) patients having upfront TRUS biopsy were confirmed to have PCa.
Were the 424 patients who did not have TRUS biopsy seen in standard OP clinic a saving of £115,328/annum would be made.
The added cost of referring for MRI after OSC and second visit in same clinic compared to initial standard OP, MRI referral and review in OSC is £5,712.
Conclusions
The facilities in the OSC strategy were heavily under-utilised despite the significant added costs.
MRI was found to be a commonly used tool for initial assessment and was noted to have a low false negative rate.
Considering the low numbers of upfront TRUS biopsies performed in conjunction with the financial savings offered by a standard OP clinic with MRI referral where appropriate, a re-design of our Trust’s PCa assessment pathway via a two-stop pathway is being devised.
