Bass Edward James, Freeman Alex, Jameson Charles, Punwani Shonit, Moore Caroline M, Arya Manit, Emberton Mark, Ahmed Hashim Uddin
Division of Surgery and Interventional Science, University College London, London, UK.
Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
BMJ Open. 2018 Oct 24;8(10):e024941. doi: 10.1136/bmjopen-2018-024941.
To evaluate the feasibility of a novel multiparametric MRI (mpMRI) and cognitive fusion transperineal targeted biopsy (MRTB) led prostate cancer (PCa) diagnostic service with regard to cancer detection and reducing time to diagnosis and treatment.
Consecutive men being investigated for possible PCa under the UK 2-week wait guidelines.
Tertiary referral centre for PCa in the UK.
Men referred with a raised prostate-specific antigen (PSA) or abnormal digital rectal examination between February 2015 and March 2016 under the UK 2-week rule guideline.
An mpMRI was performed prior to patients attending clinic, on the same day. If required, MRTB was offered. Results were available within 48 hours and discussed at a specialist multidisciplinary team meeting. Patients returned for counselling within 7 days PRIMARY AND SECONDARY OUTCOME MEASURES: Outcome measures in this regard included the time to diagnosis and treatment of patients referred with a suspicion of PCa. Quality control outcome measures included clinically significant and total cancer detection rates.
112 men were referred to the service. 111 (99.1%) underwent mpMRI. Median PSA was 9.4 ng/mL (IQR 5.6-21.0). 87 patients had a target on mpMRI with 25 scoring Likert 3/5 for likelihood of disease, 26 4/5 and 36 5/5.57 (51%) patients received a local anaesthetic, Magnetic resonance imaging targeted biopsy (MRTB). Cancer was detected in 45 (79%). 43 (96%) had University College London definition 2 disease or greater. The times to diagnosis and treatment were a median of 8 and 20 days, respectively.
This approach greatly reduces the time to diagnosis and treatment. Detection rates of significant cancer are high. Similar services may be valuable to patients with a potential diagnosis of PCa.
评估一种新型多参数磁共振成像（mpMRI）与认知融合经会阴靶向活检（MRTB）主导的前列腺癌（PCa）诊断服务在癌症检测以及缩短诊断和治疗时间方面的可行性。
按照英国两周等待指南，对因可能患有PCa而接受调查的男性进行连续研究。
英国前列腺癌三级转诊中心。
在2015年2月至2016年3月期间，根据英国两周规则指南，因前列腺特异性抗原（PSA）升高或直肠指检异常而被转诊的男性。
患者在就诊当天前来诊所之前先进行mpMRI检查。如有需要，提供MRTB。结果在48小时内可得，并在多学科专家团队会议上进行讨论。患者在7天内返回接受咨询。主要和次要结局指标：这方面的结局指标包括疑似PCa患者的诊断和治疗时间。质量控制结局指标包括临床显著癌症检出率和总癌症检出率。
112名男性被转诊至该服务。111名（99.1%）接受了mpMRI检查。PSA中位数为9.4 ng/mL（四分位间距5.6 - 21.0）。87例患者在mpMRI上有靶点，其中25例疾病可能性评分为李克特3/5，26例为4/5，36例为5/5。57例（51%）患者接受了局部麻醉下的磁共振成像靶向活检（MRTB）。45例（79%）检测到癌症。43例（96%）患有伦敦大学学院定义的2级或更高级别疾病。诊断和治疗时间中位数分别为8天和20天。
这种方法大大缩短了诊断和治疗时间。显著癌症的检出率很高。类似的服务对于可能诊断为PCa的患者可能很有价值。
