The Rapid Assessment for Prostate Imaging and Diagnosis (RAPID) prostate cancer diagnostic pathway

AbstractObjective

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 mpMRI and transperineal biopsy.

Patients and Methods

2130 patients from 3 centres who completed the RAPID pathway (3/April/2017-31/March/2020) were consecutively entered as a prospective audit not requiring ethics committee review. These were also compared to a pre-RAPID cohort of 2,435 patients. In RAPID, patients with an MRI score 4 or 5 and those with PSA density >/=0.12 and 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 RAPID.

Results

Median age and PSA were 66?years and 6.6ng/ml, respectively. Biopsy could be omitted in 43% (920/2130). A further 7.9% (168/2130) of patients declined a recommendation for biopsy. The percentage of biopsies avoided between sites did vary (45% vs 36% vs 51%, p<0.001). 30% (221/742) had a local-anaesthetic (grid-and-stepper) transperineal biopsy. Clinically significant cancer detection (any Gleason >/=3+4) was 26% (560/2130) and detection of Gleason 3+3 alone constituted 5.8% (124/2130): detection of Gleason 3+3 did not significantly vary between sites (p=0.7). Among participants who received a transperineal targeted biopsy, there was no difference in cancer detection rates between local anaesthetic, sedation and general anaesthetic. In the 2,435 patients from the pre-RAPID era time-to-diagnosis was 32.1?days (95%CI 29.3-34.9) compared to 15.9?days (95%CI 12.9-34.9) in RAPID. 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 was some centre-level variations.