Assessing the efficacy of clinical triage in the prostate cancer best practice pathway

Abstract

Objective: The Prostate Cancer UK timed prostate cancer diagnostic pathway is a new UK pathway to deliver a diagnosis within 28 days for patients with suspected prostate cancer. We aim to review our experience of implementing this pathway, in particular the success of clinical triage. Subjects/patients (or materials) and methods: We reviewed consecutive referrals to the prostate cancer best timed pathway from September 2019 to September 2020. Patients were triaged either straight to test multiparametric magnetic resonance imaging (mpMRI) or straight to outpatient clinic. Inappropriate triage was defined as either: patients referred straight to test mpMRI who were diagnosed with prostate cancer and managed with watchful waiting or androgen deprivation therapy (ADT) or patients who were referred straight to clinic who subsequently had an mpMRI and underwent radical treatment. Results: A total of 154/155 (99.6%) of patients were appropriately triaged in the straight to mpMRI group. A total of 124/132 (94.0%) of patients were appropriately triaged in the straight to clinic group (patients who required review to ascertain if mpMRI was appropriate and then received radical treatment). Conclusion: The implementation of a consultant supervised triage process has been successful in avoiding unnecessary mpMRIs or unnecessary clinic appointments before a patient received a diagnosis or reassuring test. We advise that outcomes are audited regularly to ensure the effective use of resources. Level of evidence: 2C