Abstract
Introduction
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.
Aims
The aims of this study are to assess our initial experience with particular emphasis on access times, patient demographics, detection rates and treatment outcomes.
Methods
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.
Results
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.
Conclusion
This data highlight the necessity of a RAPAC to streamline the provision of prostate cancer services in the west of Ireland.
Similar content being viewed by others
References
National Cancer Registry. Cancer Trends. Recent trends in prostate cancer. 2011 [cited; Available from: http://www.ncri.ie/pubs/pubfiles/prostate%20trends.pdf
Carsin AE, Drummond FJ, Black A, van Leeuwen PJ, Sharp L, Murray LJ, Connolly D, Egevad L, Boniol M, Autier P, Comber H, Gavin A (2010) Impact of PSA testing and prostatic biopsy on cancer incidence and mortality: comparative study between the Republic of Ireland and Northern Ireland. Cancer Causes Control 21(9):1523–1531
Department of Health and Children. A strategy for cancer control in Ireland—National Cancer Forum 2006. [cited; Available from: http://www.cancerscreening.ie/publications/CancerControlStrategy2006.pdf
Executive HS. National Cancer Control Programme Prostate Cancer Referral Guidelines. 2010 [cited; Available from: http://www.healthlink.ie/Oncology/NCCP%20Prostate%20Cancer%20Referral%20Guideline%20Version%201.3%20January%202011.pdf
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):3975–3979
Allen D, Popert R, O’Brien T (2004) The two-week-wait cancer initiative in urology: useful modernization? J R Soc Med 97(6):279–281
Mathew A, Desai KM (2009) An audit of urology two-week wait referrals in a large teaching hospital in England. Ann R Coll Surg Engl 91(4):310–312
DeAntoni EP (1997) Age-specific reference ranges for PSA in the detection of prostate cancer. Oncology 11(4):475–482
Simunovic M, Gagliardi A, McCready D, Coates A, Levine M, DePetrillo D (2001) A snapshot of waiting times for cancer surgery provided by surgeons affiliated with regional cancer centres in Ontario. CMAJ 165(4):421–425
Heidenreich A, Bolla M, Joniau S et al European Association of Urology. “Guidelines on Prostate Cancer 2011”. ( http://www.uroweb.org/fileadmin/tx_eauguidelines/2011/Full/Prostate_Cancer.pdf)
Stamatiou K, Alevizos A, Mariolis A, Spiliopoulou C, Alevizou A, Bovis K, Sofras F (2008) Do clinically insignificant tumors of the prostate exist? Urol Int 81(4):379–382
Drummond FJ, Carsin A, Sharp L, Comber H (2010) Trends in prostate specific antigen testing in Ireland: lessons from a country without guidelines. Ir J Med Sci 179(1):43–49
Schroder FH, Hugosson J, Roobol MJ et al (2009) Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 360:1320–1328
Forde JC, O’Connor KM, Casey L, O’Brien M, Bowen S, Casey RG, Ahmed I, McDermott TE, Grainger R, Lynch TH (2011) A rapid access diagnostic clinic for prostate cancer: the experience after 1 year. Ir J Med Sci 180(2):505–508
Andriole GL, Crawford ED, Grubb RL et al (2009) Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 360:1310–1319
Alsikafi NF, Brendler CB, Gerber GS, Yang XJ (2001) High-grade prostatic intraepithelial neoplasia with adjacent atypia is associated with a higher incidence of cancer on subsequent needle biopsy than high-grade prostatic intraepithelial neoplasia alone. Urology 57(2):296–300
Partin A et al (2002) High-grade prostatic intraepithelial neoplasia on a prostate biopsy—what does it mean? Rev Urol 4(3):157–158
Montironi R, Scattoni V, Mazzucchelli R, Lopez-Beltran A, Bostwick DG, Montorsi F (2006) Atypical foci suspicious but not diagnostic of malignancy in prostate needle biopsies (also referred to as “atypical small acinar proliferation suspicious for but not diagnostic of malignancy”). Eur Urol 50(4):666–674
Bostwick DG, Meiers I (2006) Atypical small acinar proliferation in the prostate: clinical significance in 2006. Arch Pathol Lab Med 130(7):952–957
Strand CL, Aponte SL, Chatterjee M, Engelbach LM, Fromowitz FB, Guo Y et al (2010) Improved resolution of diagnostic problems in selected prostate needle biopsy specimens by using the ASAP workup: a prospective study of interval sections versus new recut sections. Am J Clin Pathol 134(2):293–298
Stevens C, Bondy SJ, Loblaw DA (2010) Wait times in prostate cancer diagnosis and radiation treatment. Can Urol Assoc J 4(4):243–248
Alexander FE, Anderson TJ, Brown HK, Forrest AMP, Kirkpatrick AE, Muir BB, Prescott RJ, Smith A (1999) 14 years follow-up from the Edinburgh randomised trial of breast-cancer screening. Lancet 353:1903–1908
Conflicts of interest
None to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bolton, E.M., Kelly, B.D., Quinlan, M.R. et al. Audit of rapid access introduction reveals high prevalence of prostate cancer in Western Region. Ir J Med Sci 183, 173–179 (2014). https://doi.org/10.1007/s11845-013-0986-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-013-0986-y