Eldred-Evans David, Connor Martin J, Bertoncelli Tanaka Mariana, Bass Edward, Reddy Deepika, Walters Uma, Stroman Luke, Espinosa Easter, Das Raj, Khosla Nalin, Tam Henry, Pegers Elizabeth, Qazi Hasan, Gordon Stephen, Winkler Mathias, Ahmed Hashim U
Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
Imperial Urology, Imperial College Healthcare NHS Trust, London, UK.
BJU Int. 2023 Apr;131(4):461-470. doi: 10.1111/bju.15899. Epub 2022 Nov 10.
To report outcomes within the Rapid Assessment for Prostate Imaging and Diagnosis (RAPID) diagnostic pathway, introduced to reduce patient and healthcare burdens and standardize delivery of pre-biopsy multiparametric magnetic resonance imaging (MRI) and transperineal biopsy.
A total of 2130 patients from three centres who completed the RAPID pathway (3 April 2017 to 31 March 2020) were consecutively entered as a prospective registry. These patients were also compared to a pre-RAPID cohort of 2435 patients. Patients on the RAPID pathway with an MRI score 4 or 5 and those with PSA density ≥0.12 and an MRI score 3 were advised to undergo a biopsy. Primary outcomes were rates of biopsy and cancer detection. Secondary outcomes included comparison of transperineal biopsy techniques, patient acceptability and changes in time to diagnosis before and after the introduction of RAPID.
The median patient age and PSA level were 66 years and 6.6 ng/mL, respectively. Biopsy could be omitted in 43% of patients (920/2130). A further 7.9% of patients (168/2130) declined a recommendation for biopsy. The percentage of biopsies avoided among sites varied (45% vs 36% vs 51%; P < 0.001). In all, 30% (221/742) had a local anaesthetic (grid and stepper) transperineal biopsy. Clinically significant cancer detection (any Gleason score ≥3 + 4) was 26% (560/2130) and detection of Gleason score 3 + 3 alone constituted 5.8% (124/2130); detection of Gleason score 3 + 3 did not significantly vary among sites (P = 0.7). Among participants who received a transperineal targeted biopsy, there was no difference in cancer detection rates among local anaesthetic, sedation and general anaesthetic groups. In the 2435 patients from the pre-RAPID cohor, time to diagnosis was 32.1 days (95% confidence interval [CI] 29.3-34.9) compared to 15.9 days (95% CI 12.9-34.9) in the RAPID group. A total of 141 consecutive patient satisfaction surveys indicated a high satisfaction rate with the pathway; 50% indicated a preference for having all tests on a single day.
The RAPID prostate cancer diagnostic pathway allows 43% of men to avoid a biopsy while preserving good detection of clinically significant cancers and low detection of insignificant cancers, although there were some centre-level variations.
报告前列腺成像与诊断快速评估（RAPID）诊断路径的相关结果，该路径旨在减轻患者和医疗负担，并规范活检前多参数磁共振成像（MRI）及经会阴活检的实施。
来自三个中心的2130例完成RAPID路径（2017年4月3日至2020年3月31日）的患者被连续纳入前瞻性登记研究。这些患者还与2435例RAPID实施前队列的患者进行了比较。RAPID路径中MRI评分为4或5分以及PSA密度≥0.12且MRI评分为3分的患者被建议进行活检。主要结局为活检率和癌症检出率。次要结局包括经会阴活检技术的比较、患者可接受性以及RAPID实施前后诊断时间的变化。
患者年龄中位数和PSA水平分别为66岁和6.6 ng/mL。43%（920/2130）的患者可免于活检。另有7.9%（168/2130）的患者拒绝活检建议。各中心避免活检的比例有所不同（45%对36%对51%；P<0.001）。总共30%（221/742）的患者接受了局部麻醉（网格和步进式）经会阴活检。临床显著癌（任何Gleason评分≥3+4）的检出率为26%（560/2130），仅Gleason评分3+3的检出率为5.8%（124/2130）；Gleason评分3+3的检出率在各中心之间无显著差异（P=0.7）。在接受经会阴靶向活检的参与者中，局部麻醉、镇静和全身麻醉组的癌症检出率无差异。在RAPID实施前队列的2435例患者中，诊断时间为32.1天（95%置信区间[CI]29.3-34.9），而RAPID组为15.9天（95%CI 12.9-34.9）。总共141份连续的患者满意度调查表明对该路径的满意度较高；50%的患者表示倾向于在同一天完成所有检查。
RAPID前列腺癌诊断路径使43%的男性能够避免活检，同时保持对临床显著癌的良好检出率和对非显著癌的低检出率，尽管存在一些中心层面的差异。
