Audit of rapid access introduction reveals high prevalence of prostate cancer in Western Region

• Published in: Irish journal of medical science Vol. 183; no. 2; pp. 173 - 179
• Main Authors: Bolton, E. M., Kelly, B. D., Quinlan, M. R., D’Arcy, F. T., Azar, M., Dowling, C. M., Power, M., McCarthy, P., Roche, C., Walsh, K., Rogers, E., Durkan, G. C.
• Format: Journal Article
• Language: English
• Published: London Springer London 01-06-2014
• Subjects: Adult; Aged; Aged, 80 and over; Biopsy; Family Medicine; General Practice; Hospitals, University; Humans; Internal Medicine; Ireland - epidemiology; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Original Article; Prevalence; Prostate - pathology; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - epidemiology; Prostatic Neoplasms - therapy; Referral and Consultation - statistics & numerical data; Time Factors; Treatment Outcome; Waiting Lists; Ireland; Rapid access clinics; Digital rectal examination; Prostate cancer; PSA
• ISSN: 0021-1265; 1863-4362
• DOI: 10.1007/s11845-013-0986-y

Introduction
Men with symptoms suggestive of prostate cancer are now directly referred by their general practitioners to rapid access prostate assessment clinics (RAPACs). This service implements recommendations outlined by the National Cancer Control Programme. The RAPAC was introduced at Galway University Hospital, Galway, Ireland in June 2009, aiming to structure GP referral of patients with suspected prostate cancer to a urology service.
Aims
The aims of this study are to assess our initial experience with particular emphasis on access times, patient demographics, detection rates and treatment outcomes.
Methods
Data on all patients presenting to the RAPAC during the preliminary 2-year period have been gathered prospectively and analysed using standard parametric analysis methods.
Results
A total of 1,106 patients were reviewed at 278 clinic sessions during the initial 2-year period. The average waiting time to first clinic visit was 18 days (12–39 days). The mean age of referral to the clinic is 65 years (44–88 years). The mean PSA is 16.31 g/dL (0.4–845 g/dL). Of the 1106 patients undergoing TRUS biopsies, 503 (45.5 %) patients were diagnosed with prostate cancer. Further analysis patient demographics and cancer grading is presented in the article. Seventy-one patients (14.1 %) underwent radical retropubic prostatectomy. Sixty-seven patients (13.3 %) are being followed on an active monitoring programme, whilst 235 (56.7 %) received primary treatment with external beam radiotherapy and 68 (13.5 %) received brachytherapy.
Conclusion
This data highlight the necessity of a RAPAC to streamline the provision of prostate cancer services in the west of Ireland.