Advertisement

Irish Journal of Medical Science

, Volume 182, Issue 3, pp 487–491 | Cite as

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)

  • F. O’Kelly
  • A. Z. Thomas
  • D. Murray
  • P. Lee
  • R. F. O’Carroll
  • P. Nicholson
  • H. Forristal
  • N. Swan
  • D. Galvin
  • D. Mulvin
  • D. M. Quinlan
Original Article

Abstract

Background

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

Aims

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

Methods

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

Results

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

Conclusion

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

Keywords

Prostate cancer Gleason grade Distance Prostate-specific antigen (PSA) Rapid access prostate clinic Migration 

Notes

Conflict of interest

None.

References

  1. 1.
    Cancer in Ireland (2011) Annual report of the national cancer registry. National cancer registry Ireland. http://www.ncri.ie/pubs/pubfiles/AnnualReport2011.pdf
  2. 2.
    Drummond FJ, Carsin AE, Sharp L et al (2010) Trends in prostate specific antigen testing in Ireland: lessons from a country without guidelines. Ir J Med Sci 179:43–49PubMedCrossRefGoogle Scholar
  3. 3.
    Saad F, Finelli A, Dranitsaris G et al (2006) Does prolonging the time to prostate cancer surgery impact long-term cancer control: a systematic review of the literature. Can J Urol 13(S3):16–24PubMedGoogle Scholar
  4. 4.
    Kavanagh AG, Lee JC, Donnelly B (2008) Time to treatment of prostate cancer through the Calgary Prostate Institute rapid access clinic. Can J Urol 15(2):3975–3979PubMedGoogle Scholar
  5. 5.
    Trends in Irish cancer incidence (1994–2002) With projections to 2020. National cancer registry Ireland, 2006. http://www.ncri.ie/pubs/pubfiles/proj_2020.pdf
  6. 6.
    Forde JC, O’Connor KM, Casey L et al (2011) A rapid access diagnostic clinic for prostate cancer: the experience after one year. Ir J Med Sci 180:505–508PubMedCrossRefGoogle Scholar
  7. 7.
    National Cancer Control program—prostate cancer referral guidelines (2010). Health Service Executive, 2010. http://www.hse.ie/eng/services/find_a_service/national_cancer_control_programme/health_professional_information/prostate_referral_guideline.pdf
  8. 8.
    Osterling JE (1996) Age-specific reference ranges for PSA. N Engl J Med 335:345–346CrossRefGoogle Scholar
  9. 9.
    Healthlink (2010) The national healthlink project, 2010. http://www.healthlink.ie/index.htm
  10. 10.
    Brawer MK, Chetner MP, Beatie J et al (1992) Screening for prostatic carcinoma with prostate specific antigen. J Urol 147(3 Pt. 2):841–845PubMedGoogle Scholar
  11. 11.
    Gilliland FD, Gleason DF, Hunt WC et al (2001) Trends in Gleason score for prostate cancer diagnosed between 1983 and 1993. J Urol 165(3):846–850PubMedCrossRefGoogle Scholar
  12. 12.
    Holmes JA, Carpenter WR, Wu Y et al (2012) Impact of distance to a urologist on early diagnosis of prostate cancer among black and white patients. J Urol 187(3):883–888PubMedCrossRefGoogle Scholar
  13. 13.
    Panagopoulou P, Gogas H, Dessypris N et al (2012) Survival from breast cancer in relation to access to tertiary healthcare, body mass index, tumour characteristics and treatment: a Hellenic Cooperative Oncology Group (HeCOG) study. Eur J Epidemiol 27(11):857–866PubMedCrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2013

Authors and Affiliations

  • F. O’Kelly
    • 1
  • A. Z. Thomas
    • 1
  • D. Murray
    • 1
  • P. Lee
    • 1
  • R. F. O’Carroll
    • 1
  • P. Nicholson
    • 1
  • H. Forristal
    • 1
  • N. Swan
    • 2
  • D. Galvin
    • 1
  • D. Mulvin
    • 1
  • D. M. Quinlan
    • 1
  1. 1.Department of Urological SurgerySt. Vincent’s University HospitalElm ParkDublin 4
  2. 2.Department of HistopathologySt. Vincent’s University HospitalElm ParkDublin 4

Personalised recommendations