Storino Ramacciotti Lorenzo, Kaneko Masatomo, Rodler Severin, Mohideen Muneeb, Cai Jie, Liang Gangning, Aron Manju, Hopstone Michelle, Stern Mariana C, Cacciamani Giovanni E, Gill Inderbir, Abreu Andre Luis
USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine University of Southern California Los Angeles California USA.
Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine University of Southern California Los Angeles California USA.
BJUI Compass. 2024 Oct 23;5(12):1278-1287. doi: 10.1002/bco2.447. eCollection 2024 Dec.
To assess the carbon footprint, accessibility, and diagnostic performance of an expedited 'One-Stop' prostate cancer (PCa) diagnostic pathway.
A total of 1083 consecutive patients undergoing magnetic resonance imaging (MRI) followed by transrectal ultrasound fusion-guided prostate biopsy (PBx) were identified from a prospective database. The patients were divided according to the diagnostic pathway: One-Stop, with MRI and same-day PBx (3 hours apart), or Standard, with MRI followed by a second visit for PBx. Socioeconomic status was evaluated by the Distressed Communities Index (DCI) and the carbon footprint by the United States (U.S.) Environmental Protection Agency Greenhouse Gases Equivalencies Calculator.
Overall, 260 patients underwent the One-Stop and 823 the Standard pathway. The One-Stop patients lived farther from the hospital (163 vs. 23 km; < 0.001), had lower socioeconomic status with DCI scores of 49 versus 30 ( < 0.001), and were more likely to be Latinos (21% vs. 13%, < 0.001) compared to the Standard patients, respectively. The One-Stop saved 69 575 km in round trips, over 16 tons of travel-related CO emissions, and $8214 U.S. dollars. For patients with Prostate Imaging Reporting & Data System (PIRADS) 3-5, the clinically significant PCa detection (53% vs. 50%, = 0.55) was similar for the One-Stop and Standard pathways, respectively.
The One-Stop PCa diagnostic pathway reduces carbon footprint, distance travelled, and patient-level cost while maintaining clinical outcomes comparable to the Standard pathway. It facilitates access to tertiary-level care for minorities and underserved populations.
评估一种快速“一站式”前列腺癌（PCa）诊断途径的碳足迹、可及性和诊断性能。
从一个前瞻性数据库中识别出1083例连续接受磁共振成像（MRI）检查并随后接受经直肠超声融合引导下前列腺穿刺活检（PBx）的患者。患者根据诊断途径进行分组：一站式组，即接受MRI检查并在同一天进行PBx（间隔3小时）；标准组，即接受MRI检查后第二次就诊时进行PBx。通过困境社区指数（DCI）评估社会经济地位，通过美国环境保护局温室气体当量计算器评估碳足迹。
总体而言，260例患者接受了一站式诊断途径，823例患者接受了标准诊断途径。一站式组患者居住距离医院更远（163 vs. 23公里；<0.001），社会经济地位较低，DCI评分为49分，而标准组为30分（<0.001），与标准组患者相比，一站式组患者更有可能是拉丁裔（21% vs. 13%，<0.001）。一站式诊断途径节省了69575公里的往返路程、超过16吨与出行相关的二氧化碳排放量以及8214美元的费用。对于前列腺影像报告和数据系统（PIRADS）3 - 5级的患者，一站式和标准诊断途径的临床显著PCa检测率（分别为53% vs. 50%，P = 0.55）相似。
一站式PCa诊断途径在保持与标准途径相当的临床结果的同时，减少了碳足迹、出行距离和患者层面的成本。它有助于为少数族裔和服务不足的人群提供三级医疗服务。
