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Piloting a new streamlined pathway for prostate cancer

RM Partners is piloting a new prostate cancer pathway at three hospitals across west London – Charing Cross Hospital, Epsom Hospital and St George’s@Queen Mary’s Hospital in Roehampton. The new scanning and diagnosis model – RAPID (Rapid Assessment Prostate Imaging and Diagnosis) – provides a ‘one stop shop’ for men with suspected prostate cancer.

The usual process for men referred by their GP is an MRI scan followed days to weeks later by a biopsy, where around a dozen samples may be taken blindly but systematically with a needle through rectum, with the hope of locating any suspect growths in the prostate. With RAPID, men undergo a multi-parametric MRI (mp-MRI) in the first diagnostic stage.

This is analysed by highly specialised and experienced uro-radiologists in close to real time to allow the patient to be told the outcome of their scan on the same day. Men who have a very low risk of prostate cancer can safely avoid an unnecessary biopsy and have their care transferred back to their GP for appropriate follow up.

Those men who require further investigation are offered a transperineal FUSION biopsy, one that takes tissue samples from the perineum rather than through the rectum. A FUSION biopsy uses precision equipment that overlays ultrasound images with 3D MRI scans to create a highly detailed map of the prostate.

This allows the clinician to accurately target suspect areas and allows samples to be taken from the exact locations of lesions seen on the scan. This can reduce the number of samples necessary to make a diagnosis and significantly reduces the risk of life-threatening sepsis and other complications, such as incontinence and erectile dysfunction.

Prostate cancer is diagnosed in over 40,000 men in the UK every year. Between 120,000-150,000 men are biopsied every year in the UK in a bid to diagnose those with prostate cancer. Approximately 10,000 men die of the disease each year.

The RAPID pathway was developed to change the existing pathway so that men with prostate cancer that needs treating are identified early and treated appropriately.

The key benefits of RAPID when compared to the current pathway include:

  • Men with a high PSA are seen within 10-14 days from GP referral
  • All diagnostics can be completed on the same day
  • Men with a very low cancer risk are informed of this on the day
  • There is a reduced risk of infection after biopsy
  • Fewer samples taken at each biopsy
  • Men with significant cancers are identified and moved rapidly to treatment
  • Men with non-significant disease are discharged back to primary care with support and guidance for the GP in managing this patient

It is estimated that over the two year pilot at least 5,000 men will be seen across the three locations.