Publications
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Simmons LAM, Kanthabalan A, Arya M, et al., 2019, Prostate Imaging Compared to Transperineal Ultrasound-guided biopsy for significant prostate cancer Risk Evaluation (PICTURE): a prospective cohort validating study assessing Prostate HistoScanning, PROSTATE CANCER AND PROSTATIC DISEASES, Vol: 22, Pages: 261-267, ISSN: 1365-7852
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- Citations: 8
Eldred-Evans D, Ahmed HU, 2019, Re-thinking active surveillance for the multiparametric magnetic resonance imaging era (vol 123, pg 376, 2019), BJU INTERNATIONAL, Vol: 123, Pages: 909-909, ISSN: 1464-4096
Hamid S, Donaldson IA, Hu Y, et al., 2019, The smart target biopsy trial: a prospective, within-person randomised, blinded trial comparing the accuracy of visual-registration and magnetic resonance imaging/ultrasound image-fusion targeted biopsies for prostate cancer risk stratification, European Urology, Vol: 75, Pages: 733-740, ISSN: 0302-2838
Background: Multiparametric magnetic resonance imaging (mpMRI)-targeted prostate biopsies can improve detection of clinically significant prostate cancer and decrease the overdetection of insignificant cancers. Whether visual-registration targeting is sufficient or if augmentation with image-fusion software is needed is unknown. Objective: To assess concordance between the two methods.Design, Setting, and Participants: We conducted a blinded, within-person randomised, paired validating clinical trial. From 2014 to 2016, 141 men who had undergone a prior (positive or negative) transrectal ultrasound biopsy and had a discrete lesion on mpMRI (score 3 to 5) requiring targeted transperineal biopsy were enrolled at a UK academic hospital; 129 underwent both biopsy strategies and completed the study. Intervention: The order of performing biopsies using visual-registration and a computer-assisted MRI/ultrasound image-fusion system (SmartTarget) on each patient was randomised. The equipment was reset between biopsy strategies to mitigate incorporation bias. Outcome Measurements and Statistical Analysis: The proportion of clinically significant prostate cancer (primary outcome: Gleason pattern ≥3+4=7, maximum cancer core length ≥4 mm; secondary outcome: Gleason pattern ≥4+3=7, maximum cancer core length ≥6 mm) detected by each method was compared using McNemar's test of paired proportions.Results and Limitations: The two strategies combined detected 93 clinically significant prostate cancers (72% of the cohort). Each strategy detected 80/93 (86%) of these cancers; each strategy identified 13 cases missed by the other. Three patients experienced adverse events related to biopsy (urinary retention, urinary tract infection, nausea and vomiting). No difference in urinary symptoms, erectile function, or quality of life between baseline and follow-up (median 10.5 weeks) was observed. The key limitation was lack of parallel-group randomisation and limit on number
Sathianathen N, Omer A, Moore C, et al., 2019, NEGATIVE PREDICTIVE VALUE OF MULTI-PARAMETRIC MRI IN DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS, 114th Annual Meeting of the American-Urological-Association (AUA), Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E341-E341, ISSN: 0022-5347
Lovegrove C, Brown L, Miah S, et al., 2019, COMPARISON OF TRUS-BIOPSY TO TRANSPERINEAL TEMPLATE MAPPING BIOPSIES STRATIFIED BY MRI SCORE WITHIN THE PROMIS TRIAL, 114th Annual Meeting of the American-Urological-Association (AUA), Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E425-E426, ISSN: 0022-5347
Johnston M, Shah T, Emara A, et al., 2019, REZUM WATER VAPOUR ABLATION THERAPY FOR BENIGN PROSTATIC HYPERPLASIA: INITIAL RESULTS FROM THE UNITED KINGDOM, JOURNAL OF UROLOGY, Vol: 201, Pages: E1-E2, ISSN: 0022-5347
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- Citations: 2
Marconi L, Stonier T, Tourinho-Barbosa R, et al., 2019, ROBOTIC ASSISTED RADICAL PROSTATECTOMY AFTER FOCAL THERAPY: ONCOLOGICAL AND FUNCTIONAL OUTCOMES, 114th Annual Meeting of the American-Urological-Association (AUA), Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E1146-E1146, ISSN: 0022-5347
Marconi L, Stonier T, Tourinho-Barbosa R, et al., 2019, SITE OF DISEASE RECURRENCE FOLLOWING PROSTATE FOCAL THERAPY PREDICTS ONCOLOGICAL OUTCOME AFTER SALVAGE ROBOTIC ASSISTED RADICAL PROSTATECTOMY, 114th Annual Meeting of the American-Urological-Association (AUA), Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E1147-E1148, ISSN: 0022-5347
Shah TT, Peters M, Reddy D, et al., 2019, A COMPARISON OF CANCER CONTROL OUTCOMES AT 5 YEARS OF FOCAL THERAPY (USING HIFU & CRYOTHERAPY) TO RADICAL PROSTATECTOMY FOR CLINICALLY SIGNIFICANT NON-METASTATIC PROSTATE CANCER: PROPENSITY SCORE-MATCHED ANALYSIS, 114th Annual Meeting of the American-Urological-Association (AUA), Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E1145-E1146, ISSN: 0022-5347
Khoo CC, Eldred-Evans D, Jaenicke J, et al., 2019, LIKERT VS. PI-RADS V2: A COMPARISON OFTWORADIOLOGICAL SCORING SYSTEMS FOR DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER, 114th Annual Meeting of the American-Urological-Association (AUA), Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0022-5347
Davda R, Orczyk C, Prentice M, et al., 2019, Late toxicity described using patient reported outcomes measures (PROMS) in men treated with salvage radiation following primary high intensity focal ultrasound (HIFU) for localized prostate cancer., ASCO-SITC Clinical Immuno-Oncology Symposium, Publisher: AMER SOC CLINICAL ONCOLOGY, ISSN: 0732-183X
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- Citations: 1
Eldred-Evans D, Ahmed HU, 2019, Re-thinking active surveillance for the multiparametric magnetic resonance imaging era, BJU INTERNATIONAL, Vol: 123, Pages: 376-377, ISSN: 1464-4096
Serra De Oliveira Marconi L, Stonier T, De Luyk N, et al., 2019, Robotic assisted radical prostatectomy after focal therapy: Oncological and functional outcomes, European Urology Supplements, Vol: 18, Pages: e1047-e1047, ISSN: 1569-9056
Sathianathen N, Omer A, Kasivisvanathan V, et al., 2019, Negative predictive value of multi-parametric MRI in detection of clinically significant prostate cancer: A systematic review and meta-analysis, European Urology Supplements, Vol: 18, Pages: e1817-e1817, ISSN: 1569-9056
Khoo CC, Eldred-Evans D, Jaenicke J, et al., 2019, Likert vs. PI-RADS v2: A comparison of two radiological scoring systems for detection of clinically significant prostate cancer, European Urology Supplements, Vol: 18, Pages: e1865-e1866, ISSN: 1569-9056
Miah S, Tharakan T, Gallagher KA, et al., 2019, The effects of testosterone replacement therapy on the prostate: a clinical perspective [version 1; referees: 2 approved], F1000Research, Vol: 8, ISSN: 2046-1402
Male hypogonadism is a clinical syndrome characterized by low testosterone and symptoms of androgen deficiency. Prostate cancer remains a significant health burden and cause of male mortality worldwide. The use of testosterone replacement therapy drugs is rising year-on-year for the treatment of androgen deficiency and has reached global proportions. As clinicians, we must be well versed and provide appropriate counseling for men prior to the commencement of testosterone replacement therapy. This review summarizes the current clinical and basic science evidence in relation to this commonly encountered clinical scenario. There is gathering evidence that suggests, from an oncological perspective, that it is safe to commence testosterone replacement therapy for men who have a combination of biochemically confirmed androgen deficiency and who have either had definitive treatment of their prostate cancer or no previous history of this disease. However, patients must be made aware and cautioned that there is a distinct lack of level 1 evidence. Calls for such studies have been made throughout the urological and andrological community to provide a definitive answer. For those with a diagnosis of prostate cancer that remains untreated, there is a sparsity of evidence and therefore clinicians are "pushing the limits" of safety when considering the commencement of testosterone replacement therapy.
Miah S, Servian P, Patel A, et al., 2019, A prospective analysis of robotic targeted MRI-US fusion prostate biopsy using the centroid targeting approach, Journal of Robotic Surgery, Vol: 14, Pages: 69-74, ISSN: 1863-2483
Robotic prostate biopsy is an emerging technology. Recent development of this tool has allowed the performance of a transperineal prostate biopsy allowing pre-programmed standardized biopsy schemes. Prospective data collection was undertaken in 86 consecutive men who underwent robotically assisted transperineal prostate biopsy. All underwent a multi-parametric MRI pre-biopsy with centroid targeting followed by systematic template prostate biopsy. For the purposes of this study, our definition of clinically significant prostate cancer (csPCa) is any Gleason score > 6. Mean (SD) age, median (IQR) PSA, and median (IQR) prostate volume were 64.24 (6.97) years, of 7.79 ng/ml (6.5) and 45.06 cc (28), respectively. Overall, 44 (51.2%) men were diagnosed with csPCa. csPCa was detected in the targeted biopsies alone in 35 (40.1%) men. The addition of the 12-zone template biopsy increased the yield of csPCa for another 9 (10.5%) men. Of these 9 men, the majority (7) harbored primary pattern 3 disease and only 1 was identified to have high-grade disease. Out of these 9 men, 7 of them had the identification of csPCa in the sector, where a target was contained within that zone. Robotic-assisted prostate biopsy in our study has demonstrated a high detection of csPCa when combined with limited near-field sampling. Our study suggests the use of more accurate biopsy schemes such as ring-targeting of lesions to mitigate against systematic and random mathematical errors. Adoption of this tool and biopsy strategy would potentially avoid the increased morbidity associated with whole gland systematic unguided biopsies.
Valerio M, Emberton M, Ahmed HU, 2019, Re: Henk G. van der Poel, Roderick C.N. van den Bergh, Erik Briers, et al. Focal Therapy in Primary Localised Prostate Cancer: The European Association of Urology Position in 2018. Eur Urol 2018;74:84-91, European Urology, Vol: 75, Pages: e21-e22, ISSN: 0302-2838
Miah S, Dunford C, Edison M, et al., 2019, A prospective clinical, cost and environmental analysis of a clinician-led virtual urology clinic, Annals of The Royal College of Surgeons of England, Vol: 101, Pages: 30-34, ISSN: 0035-8843
INTRODUCTION: Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism is dependent upon accurate prediction of single-gland disease on the basis of preoperative imaging and biochemistry. The aims of this study were to validate currently available predictive models of single-gland disease in two UK cohorts and to determine if these models can facilitate MIP. MATERIAL AND METHODS: We collected data prospectively from our weekly follow-up virtual clinic over a continuous four-month period between July and September 2017. RESULTS: In total, we reviewed 409 patients. Following virtual clinic consultation, 68.5% of our patients were discharged from further follow-up. The majority of our patients (male 57.7%, female 55.5%) were of working age. The satisfaction scores were high, at 90.1%, and there were no reported adverse events as a result of using the virtual clinic. Our calculated cost savings were £18,744, with a predicted 12-month cost saving of £56,232. The creation of additional face-to-face clinic capacity has created an estimated 12-month increase in tariff generation for our unit of £72,072. In total, 4623 travel miles were avoided by patients using the virtual clinic, with an estimated avoided carbon footprint of 0.35-1.45 metric tonnes of CO2e, depending on mode of transport. Our predicted 12-month avoided carbon footprint is 1.04-4.04 metric tonnes of CO2e. CONCLUSIONS: Our virtual clinic model has demonstrated a trifecta of positive outcomes, namely, clinical, financial and environmental benefits. The environmental importance and benefits of a virtual clinic should be promoted as a social enterprise value when engaging stakeholders in setting up such a urological service. We propose the adoption of our virtual clinic model in those urological units considering this method of telemedicine.
Olivier J, Stavrinides V, Kay J, et al., 2018, Immunohistochemical biomarker validation in highly selective needle biopsy microarrays derived from mpMRI-characterized prostates, The Prostate, Vol: 78, Pages: 1229-1237, ISSN: 0270-4137
INTRODUCTION: Diagnosing prostate cancer routinely involves tissue biopsy and increasingly image guided biopsy using multiparametric MRI (mpMRI). Excess tissue after diagnosis can be used for research to improve the diagnostic pathway and the vertical assembly of prostate needle biopsy cores into tissue microarrays (TMAs) allows the parallel immunohistochemical (IHC) validation of cancer biomarkers in routine diagnostic specimens. However, tissue within a biopsy core is often heterogeneous and cancer is not uniformly present, resulting in needle biopsy TMAs that suffer from highly variable cancer detection rates that complicate parallel biomarker validation. MATERIALS AND METHODS: The prostate cores with the highest tumor burden (in terms of Gleason score and/or maximum cancer core length) were obtained from 249 patients in the PICTURE trial who underwent transperineal template prostate mapping (TPM) biopsy at 5 mm intervals preceded by mpMRI. From each core, 2 mm segments containing tumor or benign tissue (as assessed on H&E pathology) were selected, excised and embedded vertically into a new TMA block. TMA sections were then IHC-stained for the routinely used prostate cancer biomarkers PSA, PSMA, AMACR, p63, and MSMB and assessed using the h-score method. H-scores in patient matched malignant and benign tissue were correlated with the Gleason grade of the original core and the MRI Likert score for the sampled prostate area. RESULTS: A total of 2240 TMA cores were stained and IHC h-scores were assigned to 1790. There was a statistically significant difference in h-scores between patient matched malignant and adjacent benign tissue that is independent of Likert score. There was no association between the h-scores and Gleason grade or Likert score within each of the benign or malignant groups. CONCLUSION: The construction of highly selective TMAs from prostate needle biopsy cores is possible. IHC data obtained through this method are highly reliable
Elliott D, Hamdy FC, Leslie TA, et al., 2018, Overcoming difficulties with equipoise to enable recruitment to a randomised controlled trial of partial ablation versus radical prostatectomy for unilateral localised prostate cancer, BJU International, Vol: 122, Pages: 970-977, ISSN: 1464-4096
OBJECTIVE: To describe how clinicians conceptualised equipoise in the PART (Partial prostate Ablation versus Radical prosTatectomy in intermediate risk, unilateral clinically localised prostate cancer) feasibility study and how this affected recruitment. SUBJECTS AND METHODS: PART included a QuinteT Recruitment Intervention (QRI) to optimise recruitment. Phase I aimed to understand recruitment, and included scrutinising recruitment data, interviewing the Trial Management Group and recruiters (n=13), and audio-recording recruitment consultations (n=64). Data were analysed using qualitative content and thematic analysis methods. In Phase II, strategies to improve recruitment were developed and delivered. RESULTS: Initially many recruiters found it difficult to maintain a position of equipoise and held preconceptions about which treatment was best for particular patients. They did not feel comfortable about approaching all eligible patients, and when the study was discussed, biases were conveyed through the use of terminology, poorly balanced information and direct treatment recommendations. Individual and group feedback led to presentations to patients becoming clearer and enabled recruiters to reconsider their sense of equipoise. Although the precise impact of the QRI alone cannot be determined, recruitment increased (from mean 1.4 (range=0-4) to 4.5 (range=0-12) patients per month) and the feasibility study reached its recruitment target. CONCLUSION: Although clinicians find it challenging to recruit participants to a trial comparing different contemporary treatments for prostate cancer, training and support can enable recruiters to become more comfortable with conveying equipoise and providing clearer information to patients.
Miah S, Eldred-Evans D, Simmons LAM, et al., 2018, Patient reported outcome measures for transperineal template prostate mapping biopsies in the PICTURE study, Journal of Urology, The, Vol: 200, Pages: 1235-1240, ISSN: 0022-5347
Purpose:Transperineal prostate mapping (TTPM) biopsy is an increasingly utilized method of procuring tissue from men with suspected prostate cancer. We sought to report the patient related outcome measures (PROMs) and adverse events in men undergoing this diagnostic test within the PICTURE trial. Material and Methods:249 men underwent a mpMRI followed by a TTPM biopsy as a validation study. Pre-and post-TTPM functional outcomes were prospectively collected and recorded using IPSS, IPSS-QoL, IIEF-15 and EPIC-Urinary function questionnaires. Results:Mean age, median PSA and median gland size was 62 years, 6.8 ng/ml and 37ml, respectively. At TTPM biopsy, a median (IQR) 49 (40-55) cores were taken. Mean time for completion of post-procedure PROMs questionnaires was 46 days. Adverse events included post procedure acute urinary retention (24%), rectal pain (26%) and perineal pain (41%). TTPM-biopsy resulted in a statistically significant increase in IPSS (10.9 to 11.8; p=0.024) and IPSS-QoL score (1.57 to 1.76; p=0.03). The erectile function score on IIEF-15 declined by 23.2% (47.7 to 38.7; p<0.001). Significant deterioration in all 5 functional domains of IIEF-15 (erectile and orgasmic function, sexual desire, intercourse and overall satisfaction; p<0.001) occurred. EPIC-Urinary scores showed no overall change from baseline. Conclusions:TTPM-biopsy causes a high urinary retention rate and a detrimental impact on genitourinary functional outcomes including deterioration in urinary flow and sexual function. Our findings can be used to ensure adequate counselling about TTPM-biopsies and point to a need for strategies such as mpMRI and targeted biopsies to minimize harms of TTPM-biopsy.
Marra G, Ploussard G, Ost P, et al., 2018, Focal therapy in localised prostate cancer: real-world urological perspective explored in a cross-sectional European survey, Urologic Oncology: Seminars and Original Investigations, Vol: 36, Pages: 529.e11-529.e22, ISSN: 1078-1439
INTRODUCTION: The urological community's opinion over focal therapy (FT) for prostate cancer (PCa) has never been assessed. Our aim was to investigate the current opinion on FT in the European urological community. METHODS: A 25-item questionnaire was devised according to the Cherries checklist and distributed through SurveyMonkey using a web link from November 2016 to October 2017. After a pilot validation (n = 40 urologists), the survey was sent through EAU and 9 other national European urological societies mailing list. Twitter was also used. RESULTS: We received 484 replies from 51 countries. Almost half (44.8%, n = 217) stated FT would represent a step forward, and 52.0% (n = 252) would suggest FT to a patient. Almost three-quarters (70.8%, n = 343) agreed FT will become a standard option after improvements in patient selection (n = 66) or when its effectiveness will be proven (n = 78), or both (n = 199). Most frequently used definition of FT was treatment of all significant (life-threatening) cancer foci whilst leaving untreated the rest of the gland (39.3%, n = 190). FT use was considered as an alternative to whole-gland treatments by 29.7% (n = 144), and to AS by 25.0% (n = 121). On multivariate analysis, FT availability and publications were associated with a positive opinion on FT. Conversely, attending International congresses, treating high PCa volumes and high percentages of high-risk PCa was associated with a negative opinion. CONCLUSIONS: FT is considered as an attractive option for PCa treatment by the European urological community sampled by our survey. FT availability positively influences these thoughts. The present survey suggests whilst some early adopters already embraced FT, the relative majority of the urological community is prone to embrace FT in the near future, once current areas of debate are solved.
Simmons LAM, Kanthabalan A, Arya M, et al., 2018, Accuracy of Transperineal Targeted Prostate Biopsies, Visual Estimation and Image Fusion in Men Needing Repeat Biopsy in the PICTURE Trial, JOURNAL OF UROLOGY, Vol: 200, Pages: 1227-1233, ISSN: 0022-5347
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- Citations: 34
Ball D, Kim NH, McFarlane A, et al., 2018, Propensity Score-Matched Comparison of Focal High Intensity Focused Ultrasound (HIFU) to Laparoscopic Radical Prostatectomy (LRP) for Clinically Significant Localised Prostate Cancer, National-Cancer-Research-Institute (NCRI) Cancer Conference, Publisher: NATURE PUBLISHING GROUP, Pages: 45-45, ISSN: 0007-0920
Miah S, Hoskings-Jervis F, Eldred-Evans D, et al., 2018, Image fusion targeted prostate biopsy in 771 men at risk: a multi-centre evaluation showing low diagnostic yield of significant cancer in non-targeted biopsies, National-Cancer-Research-Institute (NCRI) Cancer Conference, Publisher: NATURE PUBLISHING GROUP, Pages: 31-31, ISSN: 0007-0920
Guillaumier S, Peters M, Arya M, et al., 2018, A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer, European Urology, Vol: 74, Pages: 422-429, ISSN: 0302-2838
Background: Clinically significant non-metastatic prostate cancer is currently treated with whole-gland therapy. These are effective but can cause urinary, sexual and rectal side-effects. Objective: To report on 5-year prostate cancer control following focal high intensity focused ultrasound (HIFU) therapy to treat individual areas of cancer within the prostate.Design: Prospective study of consecutive patients who underwent focal therapy using HIFU (Sonablate) (1st/January/2006-31st/December/2015). Setting: Secondary care centres.Participants: 625 consecutive patients with non-metastatic clinically significant prostate cancer undergoing focal HIFU, of whom 599 had minimum 6 months follow-up. 505 (84%) had intermediate or high-risk prostate cancer.Interventions: Disease was localised using multi-parametric MRI, combined with targeted and systematic biopsies, or transperineal mapping biopsies. Areas of significant disease were treated. Follow-up included PSA, mpMRI and biopsies.Outcome Measurements and Statistical Analysis: The primary endpoint, failure-free survival (FFS), was defined as freedom from radical or systemic therapy, metastases and cancer-specific mortality.Results and Limitations: Median follow-up was 56 months (35-70). Median age was 65 years (IQR 61-71) and median pre-operative PSA 7.2ng/ml (IQR 5.2-10.0). FFS (95%CI) at 1, 3 and 5 years was 99% (98-100), 92% (90-95) and 88% (85-91). For low, intermediate and high-risk patients, metastasis-free, cancer-specific and overall survival at 5-years was 98% (97-99), 100% and 99% (97-100), respectively. In those patients returning validated questionnaires, 241/247 (98%) achieved complete pad-free urinary continence and none required more than one pad per day. Limitation includes lack of long-term follow-up.Conclusions: Focal therapy for select patients with clinically significant non-metastatic prostate cancer is effective in the medium term and has low probabilities of side-effects. Patient summary: In this m
Miah S, Winkler M, Ahmed HU, 2018, Re: Predictors of infectious complications after targeted prophylaxis for prostate needle biopsy, European Urology, Vol: 74, Pages: 523-524, ISSN: 0302-2838
Papagiannopoulos D, Abern M, Wilson N, et alJ Urol 2018;199:155–60Experts’ summary:Papagiannopoulos et al [1] are to be congratulated on their reporting of over 5000 men undergoing transrectal ultrasound-guided (TRUS) prostate biopsy with targeted antimicrobial prophylaxis with preprocedure rectal swab cultures. This method led to an overall infectious complication rate of 1.1%, whilst it was 3.9% for those harbouring a fluoroquinolone-resistant organism (odds ratio 9.98). Their article concluded that one should consider using alternative biopsy approaches to minimise infectious complications in this higher-risk cohort who harbour fluoroquinolone resistance.
Bass EJ, Freeman A, Jameson C, et al., 2018, Prostate cancer diagnostic pathway: Is a one-stop cognitive MRI targeted biopsy service a realistic goal in everyday practice? A pilot cohort in a tertiary referral centre in the UK, BMJ Open, Vol: 8, ISSN: 2044-6055
Objectives To evaluate the feasibility of a novel multiparametric MRI (mpMRI) and cognitive fusion transperineal targeted biopsy (MRTB) led prostate cancer (PCa) diagnostic service with regard to cancer detection and reducing time to diagnosis and treatment.Design Consecutive men being investigated for possible PCa under the UK 2-week wait guidelines.Setting Tertiary referral centre for PCa in the UK.Participants Men referred with a raised prostate-specific antigen (PSA) or abnormal digital rectal examination between February 2015 and March 2016 under the UK 2-week rule guideline.Interventions An mpMRI was performed prior to patients attending clinic, on the same day. If required, MRTB was offered. Results were available within 48 hours and discussed at a specialist multidisciplinary team meeting. Patients returned for counselling within 7 daysPrimary and secondary outcome measures Outcome measures in this regard included the time to diagnosis and treatment of patients referred with a suspicion of PCa. Quality control outcome measures included clinically significant and total cancer detection rates.Results 112 men were referred to the service. 111 (99.1%) underwent mpMRI. Median PSA was 9.4 ng/mL (IQR 5.6–21.0). 87 patients had a target on mpMRI with 25 scoring Likert 3/5 for likelihood of disease, 26 4/5 and 36 5/5.57 (51%) patients received a local anaesthetic, Magnetic resonance imaging targeted biopsy (MRTB). Cancer was detected in 45 (79%). 43 (96%) had University College London definition 2 disease or greater. The times to diagnosis and treatment were a median of 8 and 20 days, respectively.Conclusions This approach greatly reduces the time to diagnosis and treatment. Detection rates of significant cancer are high. Similar services may be valuable to patients with a potential diagnosis of PCa.
Chandak P, Byrne N, Lynch H, et al., 2018, Three-dimensional printing in robot-assisted radical prostatectomy - an Idea, Development, Exploration, Assessment, Long-term follow-up (IDEAL) Phase 2a study, BJU International, Vol: 122, Pages: 360-361, ISSN: 1464-4096
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