Reducing timelines in a time of increased demands
- To work collaboratively with all those involved in the pathway
- Try and trim off time at each step of the pathway without compromising patient care
mpMRI and biopsy
- Target the lesion, sample the other side
- Once you are happy with your MRI/targeted biopsy pathway, allow men with a negative MRI and low PSA density to choose not to have standard biopsy
- mpMRI is an effective, validated diagnostic tool in the detection of prostate cancer but, as a limited resource, should be used wisely and appropriately.
- Urologists should refrain from undertaking routine transrectal biopsy in patients with a marginally raised PSA without considering all factors in the decision making process e.g. FHX, DRE findings, BRCA status, MRI findings and PSA density.
- Transrectal biopsy is not without its morbidity and should not be used as a screening biopsy tool.
Pathology in the pathway
- Clinicians do not need knowledge of histology but must be able to interpret pathology report data correctly
- Prostate biopsy report interpretation has several unique features. “Headline” figures may be misleading
- Grade and stage are biological continuums with subjective cut-offs. In borderline cases, effective communication is more important than the accuracy of assigned grade/stage.
Patient’s perspective from the CNS
- Consider what patients expect and require from the referral process and what constitutes a good patient experience
- Understand the MRI, understand the patient, plan a strategy