Retrospective review of the diagnostic pathway of suspected prostate cancer in Mater Dei Hospital

Abstract

BACKGROUND: A well-established prostate cancer diagnostic pathway is used in Europe [1] to increase early diagnosis of clinically significant prostate cancers. This retrospective review was aimed to assess the efficiency and accuracy of this pathway within the department of urology at Mater Dei Hospital.

METHOD: Data collected included demographic data, digital rectal examination (DRE) findings prior to magnetic resonance imaging (MRI) and prostate specific antigen (PSA) values preceding MRI. PSA doubling time and PSA velocity were calculated. The cohort was divided into three groups according to the MRI result - negative, positive or equivocal for prostate cancer. Prostate gland volume, Prostate Imaging-Reporting and Data System (PI-RADS) score, TNM stage and histology results were documented and compared.

RESULTS: 41% of the cohort had a DRE suggestive of cancer. The cohort had a mean PSA value of 4.912 ng/ml, mean PSA density of 0.152 ng/ml, mean PSA velocity of 0.306 ng/ml/year and mean PSA doubling time of 64 months. The mode PIRADS count was 2. Most cancers were staged at T3a . The mean prostate size was 61.46 cubic centi-metres. 93.4% of patients with an MRI of the prostate suggestive of cancer had a prostate biopsy. 79.5% provided samples suggestive of cancer. The most common grade of cancer was Gleason 7 disease.

CONCLUSION: Allowing for limitations of a retrospective review and a small cohort, this study has shown that using the European pathway for diagnosis of prostate cancer increases diagnosis of significant prostate cancer.