Psychological distress among patients awaiting histopathologic results after prostate biopsy: An unaddressed concern

Sarchi, Luca; Eissa, Ahmed; Puliatti, Stefano; Amato, Marco; Assumma, Simone; Calcagnile, Tommaso; Ticonosco, M.; Iseppi, A.; Toso, S.; Sighinolfi, Maria Chiara; Bianchi, Giampaolo; Micali, Salvatore

doi:10.1177/03915603211049889

Cited by 6 publications

(1 citation statement)

References 39 publications

(65 reference statements)

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“…Although there remains controversy over the impact of rapid diagnostics on prostate cancer outcomes, timely diagnosis has been highlighted as an effective means to decrease psychological distress and increase patient satisfaction following a referral with a suspicion of cancer [6]. The impact of a diagnostic delay due to pathology evaluation times, which are now the most significant part of our new RAPID pathway, have been reported by Sarchi et al, with 41% of the patients questioned reporting psychological distress [27]. Improvements in pathology turnaround time will require further consideration and might be helped through projects in digital pathology [28].…”

Section: Discussionmentioning

confidence: 99%

The rapid assessment for prostate imaging and diagnosis (RAPID) prostate cancer diagnostic pathway

et al. 2022

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Objective 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. Patients and Methods 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. Results 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. Conclusions 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.

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Section: Discussionmentioning

confidence: 99%