Rapid Access Prostate Research Articles

Investigation and Assessment of Returning Patient Visits to Rapid Access Prostate Clinics in Beaumont Hospital

Investigation and Assessment of Returning Patient Visits to Rapid Access Prostate Clinics in Beaumont Hospital

Poster 16 - Is digital rectal examination in the community of value in prostate cancer detection? A retrospective review of prostate cancer rates among patients referred to rapid access prostate clinic services with abnormal primary care digital rectal examination findings

Poster 16 - Is digital rectal examination in the community of value in prostate cancer detection? A retrospective review of prostate cancer rates among patients referred to rapid access prostate clinic services with abnormal primary care digital rectal examination findings

Letter to the editor re: The Hidden workload and cost of a rapid access prostate cancer clinic: Patients with no prostate cancer. Broe et al, J Clin Urol, 26 July 2018

Letter to the editor re: The Hidden workload and cost of a rapid access prostate cancer clinic: Patients with no prostate cancer. Broe et al, <i>J Clin Urol</i>, 26 July 2018

The hidden workload and cost of a rapid access prostate cancer clinic: Patients with no prostate cancer

The hidden workload and cost of a rapid access prostate cancer clinic: Patients with no prostate cancer

What predicts emotional response in men awaiting prostate biopsy?

BackgroundIncidence of prostate cancer is increasing as opportunistic screening becomes widespread and life expectancy rises. Despite screening availability, research reveals conflicting results on medical outcomes, for example, disease specific mortality. However the gold standard in early diagnosis of potentially curable organ confined prostate cancer is transrectal ultrasound-guided systematic prostate biopsy (TRUS-BX). While focus has been given to medical sequalae there is a paucity of research on the psychological impact of biopsy. Awaiting biopsy may be inherently stressful but no studies to date, have assessed men’s perception of stress and its impact on emotional response. This study, therefore, examines the role of stress and also personal resources namely, self-efficacy and sense of coherence in emotional adjustment in men awaiting a prostate biopsy.MethodsMen attending a Rapid Access Prostate Cancer Clinic for a transrectal prostate biopsy (N = 114) participated in the study. They completed self report questionnaires on perceived stress (PSS), generalised self-efficacy (GSES), and sense of coherence (SOC). Adjustment was measured by the Profile of Mood States (POMS-B) which assesses tension, depression, anger, fatigue, confusion and vigour.ResultsHierarchical regression analyses demonstrated that the set of predictors accounted for 17%–34% of variance across six mood states and predicted 46% of total mood disturbance. Perceived stress explained variance on all domains (11%–26%) with high stress linked to poor functioning.ConclusionPerceived stress was the strongest and most consistent predictor of emotional adjustment. This is an important finding as stress appraisal has not been examined previously in this context and suggests that stress management is an important target to enhance emotional wellbeing of men attending for a prostate biopsy.

The effect of Rapid Access Prostate Clinics on the outcomes of Gleason 7 prostate cancer: does earlier diagnosis lead to better outcomes?

Rapid Access Prostate Clinics (RAPC) were introduced in Ireland by the National Cancer Control Programme bringing about expedited referral pathways and increased detection rates of prostate cancer. Lower Gleason (G) grade at diagnosis due to RAPC has been previously reported but grade at prostatectomy has not been assessed. The aim of this study was to assess the impact of RAPC on the outcomes of patients with G7 disease on radical prostatectomy (RP). A retrospective analysis was carried out of all RPs performed over a 9-year period (2006-2014). Outcomes for G7 prostatectomies were compared before and after the introduction of the RAPC, with a further sub-analysis of G4+3 versus G3+4. The primary outcome was biochemical recurrence (BCR). Other outcomes were adjuvant/salvage radiotherapy, extra prostatic extension, positive surgical margins, seminal vesicle involvement and tumour stage. In total, 240 RPs were performed with 167 cases graded G7 (70 graded G4+3 and 97 graded G3+4). Since the introduction of RAPC the proportion of G4+3 compared to G3+4 has increased from 37.9 to 42%. There was no statistical difference in outcomes for G4+3 treated before and after the introduction of RAPC. G4+3 was associated with higher rates of BCR (24.4 vs. 0%, p<0.0001, radiotherapy (41.1 vs. 4.8%, p<0.0001) and worse histological features than G3+4. Despite the benefits in diagnosis of prostate cancer brought about by RAPC in Ireland, this has not translated to a lower grade for surgically treated patients. There has been no improvement in outcomes especially for higher grade G4+3 disease.

A Circulating MicroRNA Signature as a Biomarker for Prostate Cancer in a High Risk Group.

Introduction: Mi(cro)RNAs are small non-coding RNAs whose differential expression in tissue has been implicated in the development and progression of many malignancies, including prostate cancer. The discovery of miRNAs in the blood of patients with a variety of malignancies makes them an ideal, novel biomarker for prostate cancer diagnosis. The aim of this study was to identify a unique expression profile of circulating miRNAs in patients with prostate cancer attending a rapid access prostate assessment clinic. Methods: To conduct this study blood and tissue samples were collected from 102 patients (75 with biopsy confirmed cancer and 27 benign samples) following ethical approval and informed consent. These patients were attending a prostate assessment clinic. Samples were reverse-transcribed using stem-loop primers and expression levels of each of 12 candidate miRNAs were determined using real-time quantitative polymerase chain reaction. miRNA expression levels were then correlated with clinicopathological data and subsequently analysed using qBasePlus software and Minitab. Results: Circulating miRNAs were detected and quantified in all subjects. The analysis of miRNA mean expression levels revealed that four miRNAs were significantly dysregulated, including let-7a (p = 0.005) which has known tumour suppressor characteristics, along with miR-141 (p = 0.01) which has oncogenic characteristics. In 20 patients undergoing a radical retropubic-prostatectomy, the expression levels of miR-141 returned to normal at day 10 post-operatively. A panel of four miRNAs could be used in combination to detect prostate cancer with an area under the curve (AUC) of 0.783 and a PPV of 80%. Conclusion: These findings identify a unique expression profile of miRNA detectable in the blood of prostate cancer patients. This confirms their use as a novel, diagnostic biomarker for prostate cancer.

Digital rectal examination in primary care is important for early detection of prostate cancer: a retrospective cohort analysis study.

Currently, there is no standardised screening for prostate cancer in Europe. Assessment of risk is opportunistically undertaken in consultation with the GP or urologist. Evaluation of the prostate gland consists of a prostate-specific antigen (PSA) serum level and a digital rectal examination (DRE) of the gland. DRE is an essential part of the assessment that can independently predict prostate cancer in the setting of a normal PSA level. To evaluate the clinical usefulness of the DRE in general practice and urology clinics, and to ascertain its positive predictive value and sensitivity. A retrospective analysis study of a cohort of Irish men who underwent TRUS guided biopsy of the prostate in a single Irish tertiary referral centre, despite a normal PSA level. Patients were identified from a Rapid Access Prostate Clinic patient database. Pathological biopsy results were correlated with clinical DRE findings. Patient demographics, PSA levels, and DRE findings from a prospectively established database and hospital data systems from May 2009 to October 2013 were analysed. Of 103 men referred over a 53-month period with a normal age-adjusted PSA level, 67% were referred on the basis of an abnormal DRE alone. Thirty-five per cent of males with a normal PSA had prostate cancer. DRE alone had a sensitivity and specificity of 81% and 40% respectively in diagnosing prostate cancer, with a positive predictive value of 42%. Seventy-six per cent of these men had high-grade disease. DRE is a key part of the assessment for prostate cancer. It can independently identify patients at risk of prostate cancer, with a substantial proportion of these having clinically significant disease requiring treatment. This study reinforces the importance of DRE in the primary care setting in the assessment for prostate cancer. An abnormal DRE, even in the setting of a normal PSA level, necessitates referral.

Prostate cancer risk assessment tools in an unscreened population.

To compare the prostate cancer prevention trial risk calculator (PCPT-RC) and European randomized study of screening for prostate cancer risk calculator (ERSPC-RC) in a unique unscreened population from the West of Ireland. Data was prospectively recorded for all 556 consecutive men who underwent prostate biopsy at our institution as part of the Rapid Access Prostate Assessment Clinic program in Ireland. The estimated probabilities of detecting prostate cancer and high-grade disease were calculated using the PCPT and ERSPC risk calculators. For each calculator the discriminative ability, calibration and clinical utility was assessed. Prostate cancer was detected in 49% and high-grade prostate cancer in 34% of men. Receiver operating characteristic curve analysis demonstrated that the PCPT-RCs outperformed the ERSPC-RCs for the prediction of prostate cancer areas underneath the ROC curve (AUC 0.628 vs. 0.588, p = 0.0034) and for the prediction of high-grade prostate cancer (AUC 0.792 vs. 0.690, p = 0.0029). Both risk calculators generally over-predicted the risk of prostate cancer and high-grade disease across a wide range of predicted probabilities. Decision curve analysis suggested greater net benefit using the PCPT-RCs in this population. Multivariable nomograms can further aid patient counselling for early prostate cancer detection. In unscreened men from Western Ireland, the PCPT-RCs provided better discrimination for overall prostate cancer and high-grade disease compared to the ERSPC-RC. However, both tools overpredicted the risk of cancer detection on biopsy, and it is possible that a different set of predictive variables may be more useful in this population.

Stress and self-efficacy predict psychological adjustment at diagnosis of prostate cancer.

Prostate cancer is the most frequently non-skin cancer diagnosed among men. Diagnosis, a significant burden, generates many challenges which impact on emotional adjustment and so warrants further investigation. Most studies to date however, have been carried out at or post treatment with an emphasis on functional quality of life outcomes. Men recently diagnosed with localised prostate cancer (N = 89) attending a Rapid Access Prostate Clinic to discuss treatment options completed self report questionnaires on stress, self-efficacy, and mood. Information on age and disease status was gathered from hospital records. Self-efficacy and stress together explained more than half of the variance on anxiety and depression. Self-efficacy explained variance on all 6 emotional domains of the POMS (ranging from 5–25%) with high scores linked to good emotional adjustment. Perceived global and cancer specific stress also explained variance on the 6 emotional domains of the POMS (8–31%) with high stress linked to poor mood. These findings extend understanding of the role of efficacy beliefs and stress appraisal in predicting emotional adjustment in men at diagnosis and identify those at risk for poor adaptation at this time. Such identification may lead to more effective patient management.

The effect of a Rapid Access Prostate Cancer Clinic on prostate cancer patient and disease characteristics, primary treatment and surgical workload

In 2009, Rapid Access Prostate Cancer Clinics (RAPC) were introduced to St. James's Hospital to improve the access and organisation of patients to prostate cancer investigations and treatment. To observe the effects of the RAPC on prostate cancer diagnosis, primary treatment and overall workload. Using a prospectively designed patient database, the records of all prostate cancer patients between 2007 and 2011 were retrieved and analysed. Data were obtained for age, PSA, biopsy Gleason score and primary treatment modality and charted for the observation and comparison of trends. Seven hundred and eighty-nine patients had a new diagnosis of prostate cancer between 2007 and 2011. The median PSA prior to the RAPC was 9.7-13.1 ng/ml, which decreased to 7.79-9 ng/ml after the RAPC. Prior to the RAPC, 77-81 biopsies were performed annually versus 149-271 in the post-RAPC era. Annual requirements for radical prostatectomy also increased from 12 to 27 in the post-RAPC era. Conversely, an initially increasing percentage of patients for radiotherapy was reversed in the post-RAPC period. An increasing trend for higher grade PCa (Gleason score 4 + 4 and higher) was also reversed. The introduction of a RAPC improves the overall pathological characteristics of patients with prostate cancer. However, RAPCs are also associated with a considerable increase in surgical workload. These are important considerations for units considering the incorporation of a similar facility in their institutions.

Audit of rapid access introduction reveals high prevalence of prostate cancer in Western Region

Men with symptoms suggestive of prostate cancer are now directly referred by their general practitioners to rapid access prostate assessment clinics (RAPACs). This service implements recommendations outlined by the National Cancer Control Programme. The RAPAC was introduced at Galway University Hospital, Galway, Ireland in June 2009, aiming to structure GP referral of patients with suspected prostate cancer to a urology service. The aims of this study are to assess our initial experience with particular emphasis on access times, patient demographics, detection rates and treatment outcomes. Data on all patients presenting to the RAPAC during the preliminary 2-year period have been gathered prospectively and analysed using standard parametric analysis methods. A total of 1,106 patients were reviewed at 278 clinic sessions during the initial 2-year period. The average waiting time to first clinic visit was 18 days (12-39 days). The mean age of referral to the clinic is 65 years (44-88 years). The mean PSA is 16.31 g/dL (0.4-845 g/dL). Of the 1106 patients undergoing TRUS biopsies, 503 (45.5 %) patients were diagnosed with prostate cancer. Further analysis patient demographics and cancer grading is presented in the article. Seventy-one patients (14.1 %) underwent radical retropubic prostatectomy. Sixty-seven patients (13.3 %) are being followed on an active monitoring programme, whilst 235 (56.7 %) received primary treatment with external beam radiotherapy and 68 (13.5 %) received brachytherapy. This data highlight the necessity of a RAPAC to streamline the provision of prostate cancer services in the west of Ireland.

Can delayed time to referral to a tertiary level urologist with an abnormal PSA level affect subsequent gleason grade in the opportunistically screened population?

There is growing conflict in the literature describing the effect of delayed treatment on outcomes following radical prostatectomy. There is also evidence to suggest progression of low-risk prostate cancer to develop higher grades and volumes of prostate cancer during active surveillance. It is unknown as to what affect a delay in referral of those men with abnormal screened-PSA levels have on subsequent Gleason grade. We identified 350 men through our rapid access prostate clinic who underwent TRUS biopsy for abnormal age-related PSA and/or abnormal clinical examination. Clinicopathological findings were compared for those with positive versus negative TRUS biopsies, and for those with initial delays in referral (<12 months, 12-18 months, and >18 months). We used ANOVA and Student's t-tests amongst other statistical tools to examine significance of clinical findings. Of the 350 men who underwent TRUS biopsy, those with a delay in referral of 12 months or more were significantly associated with higher PSA titers, clinically palpable disease and likelihood of diagnosis with prostate cancer. A delay of 18 months or more led to a significantly higher risk of being diagnosed with a leading grade 4 prostate cancer, which was further supported using PSA velocity as a diagnostic tool (change >0.4 ng/ml/year). We recommend that repeated asymptomatic abnormal age-related PSA readings and/or abnormal clinical examination in the screened population be referred without delay to a urologist for further assessment, enrolment into an active surveillance program or definitive subsequent treatment.

Emerging evidence for Gleason grade migration and distance impact in prostate cancer? An analysis of the rapid access prostate clinic in a tertiary referral center: St. Vincent’s University Hospital, Dublin (2009–2011)

Recent evidence has suggested that the introduction of rapid access prostate cancer programs has led to a more streamlined pathway for patients, and was designed to ultimately reduce referral delays. To identify the initial impact of the introduction of the rapid access prostate clinic on Gleason grading within the prostate cancer cohort, as well as the impact of distance from a tertiary referral center on subsequent Gleason grading. A prospective database was maintained from those men attended the rapid access prostate clinic in St. Vincent's University Hospital. Data relating to demographics, biopsy results, retrospective PSA readings, and subsequent treatment pathways were all recorded and analyzed. Statistical significance was taken at p<0.05. Prospective data from the rapid access prostate clinic illustrated similar results in patient demographics, Gleason grade and choice of treatment outcomes to other published institutions, however, for the first time demonstrate emerging evidence of the effect of the rapid access prostate clinic leading to a downward shift in Gleason grade over a 2-year period, as well as data showing an inverse correlation between leading Gleason grade and distance from our tertiary referral center. These results suggest that the introduction of the rapid access prostate clinic has initially begun to demonstrate an initial downgrading in Gleason scoring patterns. Our data also reflects a poorer Gleason score in those patients living further away from the rapid access prostate clinic. This may be in part attributed to a surge in referrals of those patients previously managed outside a tertiary institution, and suggests that patients should undergo prompt referral following suspicion for prostate cancer.

1927 ASSESSING THE VALIDITY OF THE PCPT AND ERSPC RISK CALCULATORS FOR PROSTATE CANCER IN A COHORT OF THE POPULATION AT HIGHEST RISK OF PROSTATE CANCER IN EUROPE

You have accessJournal of UrologyProstate Cancer: Detection and Screening III1 Apr 20121927 ASSESSING THE VALIDITY OF THE PCPT AND ERSPC RISK CALCULATORS FOR PROSTATE CANCER IN A COHORT OF THE POPULATION AT HIGHEST RISK OF PROSTATE CANCER IN EUROPE Dara Lundon, Brian Kelly, Garret Durkan, Eamon Rogers, and Kilian Walsh Dara LundonDara Lundon Dublin, Ireland More articles by this author , Brian KellyBrian Kelly Galway, Ireland More articles by this author , Garret DurkanGarret Durkan Galway, Ireland More articles by this author , Eamon RogersEamon Rogers Galway, Ireland More articles by this author , and Kilian WalshKilian Walsh Galway, Ireland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2084AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The current standard of diagnosis for prostate cancer is a prostate biopsy. This procedure carries with it significant risks. It is of immeasurable benefit therefore to assess the possible benefit of such a procedure before exposing a patient to the risks. Tools exist to provide a prediction of the likely outcome of a biopsy based on weighted risk-factors. Our objective was to assess the predictive accuracy of two such prediction tools: the Prostate Cancer Prevention Trial Prostate Cancer Risk Calculator(PCPT PCRC), and the European Randomized Study of Screening for Prostate Cancer Risk Calculator (ERSPC RC) in a cohort from the West of Ireland; an area with the highest incidence of Prostate Cancer in Europe. METHODS We prospectively collected the relevant information as described by the PCPT PCRC and the ERSPC RC on all men undergoing a TRUS prostate biopsy in our institution. Histological specimens were reviewed independently by two Consultant Histopathologists and information presented at a multidisciplinary Prostate Cancer Group meeting prior to final biopsy grading. The PCPT PCRC AND ERSPC RC formulae, R statistical and calculation software v2.12.1, and Minitab v16 were utilised. The prostate cancer diagnosis risk and high grade disease risk were correlated with the final biopsy histological grade. RESULTS Of 456 consecutive biopsies, ages ranged from 37 years to 71 (median 61), P.S.A ranged from 0.57 -739 (median 7.9) and cancer was subsequently diagnosed in 223 of 456 men (49%). Of these 223 cancer diagnoses, 53 (24 %)had high grade disease. Correlation with PCRC Cancer diagnosis Risk and Actual Cancer diagnosis was statistically significant (p<0.0001) and correlation with high grade disease risk and actual High Grade diagnosis was statistically significant (p<0.05) in this cohort. Correlation with ERSPC-RC for a positive prostate biopsy was statistically significant (p<0.0001) and correlation with high grade disease was also statistically significant (p<0.001) in this cohort. CONCLUSIONS The PCPT RC and the ERSPC RC both demonstrate statistically significant prediction of both prostate cancer and high grade disease diagnoses in an Irish Cohort. Both models can be used accurately in this cohort. In the context of the Rapid Access Prostate Clinic model advocated by the Irish National Cancer Control Program, where referral is without trus characterisation of the prostate, the use of the PCPT-PCRC can be used to further inform patients and physicians with regards to prostate biopsy. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e777-e778 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dara Lundon Dublin, Ireland More articles by this author Brian Kelly Galway, Ireland More articles by this author Garret Durkan Galway, Ireland More articles by this author Eamon Rogers Galway, Ireland More articles by this author Kilian Walsh Galway, Ireland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Audit of rates of sepsis post Trans Rectal Ultra Sound biopsy of the prostate and establishment of active surveillance for sepsis in the Rapid Access Prostate Clinic in University Hospital Galway: Category: Lesson in Microbiology & Infection Control

Audit of rates of sepsis post Trans Rectal Ultra Sound biopsy of the prostate and establishment of active surveillance for sepsis in the Rapid Access Prostate Clinic in University Hospital Galway: Category: Lesson in Microbiology & Infection Control

A rapid access diagnostic clinic for prostate cancer: the experience after one year

The National Cancer Control Programme is developing standards for access to diagnostics and treatment of prostate cancer. The Rapid Access Prostate Cancer (RAPC) clinic in St. James's Hospital commenced in May 2009 allowing general practitioners (GPs) more streamlined access for patients. To demonstrate that RAPC clinics allow GPs direct access to a designated cancer centre improving the prostate cancer referral process. This ultimately should reduce referral delays. A prospective analysis of all patients referred to the RAPC clinic in St. James's Hospital over a 12-month period beginning from May 2009. Over the 12-month period 215 patients were referred to the RAPC clinic. The median age was 63 years (range 45-78). The median waiting time between referral and review at the RAPC clinic was 13 days (range 1-37). The median PSA was 7.7 μg/L (range 2.6-150). In total 199 TRUS biopsies were performed, of which 46% were positive for prostate cancer. We found that 70% of all patients had a PSA ≤ 10 μg/L and of these 32% were positive for prostate cancer. For the remaining 30% of patients who had a PSA > 10 μg/L, we found 63% were positive for prostate cancer. Regarding patients diagnosed with prostate cancer 56% have been referred for radiotherapy, 13% for surgery, 13% for hormonal treatment, 10% for active surveillance and 8% watchful waiting. RAPC clinics allow GPs easier access to specialist urological opinion for patients suspected of having prostate cancer.

A prospective analysis of blood-stream infection post-transrectal ultrasound guided biopsy of the prostate in a national rapid access prostate clinic

A prospective analysis of blood-stream infection post-transrectal ultrasound guided biopsy of the prostate in a national rapid access prostate clinic