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Overview of the diagnostic pathway
Professor Raj Persad
Consultant Urological Surgeon
North Bristol NHS Trust
HCA Harley Street Clinic and Diagnostics Centre
This page provides an overview of the diagnostic pathway for prostate cancer which is illustrated below.
This captures the process which can vary between hospitals. They may complete the pathway over 28, 21 or 14 days and in maybe up to 4 hospital visits. Clearly any delays are stressful to patients. In my practice I use the ‘RAPID’ protocol, where the whole process can be completed in around 10 days. Patients I see will be triaged on clinical information sent to me beforehand and often on the phone, they have an MRI in the morning following which I see them once the MRI has been reported. Where possible, I will perform the biopsy the same afternoon but in all cases where there is no cancer suspected (in about 40% of cases) the result is delivered and the patient is reassured that they need not go forward for biopsy.
There are links on the site describing the new pathway, and also Prof Hashim Ahmed’s page on this site describing the RAPID protocol in further detail. The links can be found under my profile button. Further, there is a link to the NHS booklet on the diagnostic pathway which you are free to download and print.
Most the boxes are self-evident as to what they mean, but some need explanation and there are important observations I would make.
Firstly, the process is dependent on good quality MRI of the prostate that is then reported by a radiologist experienced in reporting images of the prostate. This is not always the case and can result in incorrect conclusions being drawn. This can lead to cancer lesions being missed and biopsy samples being taken from the wrong part of the prostate. At this point the whole process can fall apart because of lack of accuracy.
The following link to Dr Clare Allen’s page on this site illustrates what high quality MR scans look like as well as gold standard reports. A good quality MRI can avoid subjecting you to an unnecessary biopsy. Conversely it can pick up small cancers which might have gone un-noted.
It is worth remembering that at any stage of the process you are entitled to ask for a second opinion or go to a private physician. The link at the bottom of the page tells you how.
‘Further investigations if needed for cancer staging’, ie determining the possible severity of the cancer, can include such tests as bone scans or PSMA PET . See the page on staging for more information on precise meanings
MDT stands for Multi-Disciplinary Team meeting. This is a meeting between, your Urological Surgeon, the Uro-Radiologist, Specialist Urological cancer Nurses and a Uro-Oncologist, to discuss your results and suggest optimum management of your case. Treatment options will be offered to you following this meeting. Once again you are entitled to ask for a second opinion and explore other options such as focal therapy for example if your hospital does not offer it, or perhaps be referred privately for Proton Beam Therapy as another example.
NB Not all Urological Consultants will make it clear to you that treatments exist and may be available to you other than radical surgery, although all good surgeons will consider all options and refer accordingly outside their specialist area.
Finally it is always worth exploring what new treatments that may be the subject of trials that you may be able to join.
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