McCombie Steve P, Hawks Cynthia, Emery Jon D, Hayne Dickon
Fiona Stanley Hospital, Murdoch, Australia.
Fremantle Hospital, Fremantle, Australia.
BJU Int. 2015 Oct;116 Suppl 3:11-7. doi: 10.1111/bju.13100. Epub 2015 Jul 27.
To report on the structure and outcomes of a new 'One Stop' Prostate Clinic (OSPC) designed specifically for rural and remote men.
Prospective cohort study of the first 200 rural or remote men to access a new OSPC at a public tertiary-level hospital in Western Australia between August 2011 and August 2014. Men attended for urological assessment, and proceeded to same-day transrectal ultrasonography-guided prostate biopsies, if appropriate. Referral criteria were either two abnormal age-related prostate-specific antigen (PSA) levels in the absence of urinary tract infection (UTI), or an abnormal digital rectal examination (DRE) regardless of PSA level.
The median (range) distance travelled was 1545 (56-3229) km and median (range) time from referral to assessment was 33 (2-165) days. The median (range) age was 62 (38-85) years, PSA level was 6.7 (0.5-360) ng/mL and 39% (78/200) had a suspicious DRE. In all, 92% (184/200) of men proceeded to prostate biopsies, and 60% (111/184) of these men were diagnosed with prostate cancer. Our complication rate was 3.5% (6/172). Radical prostatectomy (46/111), active surveillance (28/111) and external beam radiation therapy (26/111) were the commonest subsequent treatment methods. A $1045 (Australian dollars) cost-saving per person was estimated based on the reduced need for travel with the OSPC model.
The OSPC is an effective and efficient model for assessing men suspected of having prostate cancer living in rural and remote areas of Western Australia, and this model may be applicable to other areas.
报告一家专门为农村和偏远地区男性设立的新型“一站式”前列腺诊所（OSPC）的结构和诊疗结果。
对2011年8月至2014年8月期间在西澳大利亚一家公立三级医院首次就诊于新型OSPC的200名农村或偏远地区男性进行前瞻性队列研究。男性患者前来接受泌尿外科评估，若合适则当日进行经直肠超声引导下前列腺活检。转诊标准为在无尿路感染（UTI）的情况下，年龄相关前列腺特异性抗原（PSA）水平出现两次异常，或无论PSA水平如何，直肠指检（DRE）异常。
患者行程中位数（范围）为1545（56 - 3229）千米，从转诊到评估的时间中位数（范围）为33（2 - 165）天。年龄中位数（范围）为62（38 - 85）岁，PSA水平为6.7（0.5 - 360）纳克/毫升，39%（78/200）的患者直肠指检可疑。总计92%（184/200）的男性接受了前列腺活检，其中60%（111/184）被诊断为前列腺癌。我们的并发症发生率为3.5%（6/172）。根治性前列腺切除术（46/111）、主动监测（28/111）和外照射放疗（26/111）是最常见的后续治疗方法。基于OSPC模式减少了出行需求，估计每人可节省1045澳元的费用。
OSPC是评估西澳大利亚农村和偏远地区疑似患有前列腺癌男性的一种有效且高效的模式，该模式可能适用于其他地区。
