Organisation in collaboration introduces a new pathway to allow early detection and treatment of patients with prostate cancer, providing diagnosis result to 84.5 per cent men within 28 days

Challenges:

Our ambition was substantial. The existing UK wide pathway was variable, commonly flawed and often harmful. By showing that we could change a whole network – West London – we wanted to demonstrate to the rest of the UK, and beyond, that they too could change.

RAPID would improve access for all men to the best evidence-based diagnosis, evidence that our own clinical leaders had delivered. By doing so, this would lead to early diagnosis of prostate cancer that in turn would improve cancer outcomes. By showing reduced harms, fewer and safer biopsies with fewer insignificant cancers but also greater numbers of significant cancers found earlier. Streamlining the weeks and multiple visits to one day would improve the patient experience and length of time spent waiting.

Our goals were:

- Improve patient experience

- Implement the findings from the pivotal UK-led trials, PROMIS and PRECISION, on a regional basis

- Dramatically reduce time to diagnosis to within 28 days

- Prevent harm by identifying those men who do not require biopsy

- Quickly biopsy those men who need it with a safer and more precise technique

- Identify early the majority of men with significant cancers that require treatment

Actions:

We have delivered substantial and sustained improvements:

• Patient experience was positive in the majority with negative experiences used to improve ourselves further

• Men referred with a suspicion of prostate cancer had an MRI within an average of 11 days from GP referral compared to a previous average of 23 days

• The number of men who go on to require a biopsy based on MRI has reduced by between 46% to 61% compared to almost all in the past

• There have been no episodes of sepsis in over 500 men biopsied compared to a 2% risk from transrectal biopsy

• 84.5% of men were informed of their diagnosis within 28 days (cancer or confirmed no cancer) compared to none recorded within 28 days previously

• Number of days from diagnosis-to-treatment has fallen by an average of 10 days

• Average time from referral-to-treatment at two sites was 35.5 days

• Compared to the pathway without MRI, about 10% more men were diagnosed with high-risk cancers with a 10% reduction in diagnosing insignificant cancers

Results:

- Successfully implementing the learning from clinical research in less than a year from publication. Trials were published in 2017 and 2018 and we almost immediately implemented their findings. Our leadership of that research was clearly key.

- Achievement of diagnosing the majority of patients within 28 days

- Improving 62 days performance for prostate cancer as a region from 83.2% (Q1 17/18) to 86.9% (Q3 17/18)

The wider benefits of the collaborative nature of the project have been:

- Procuring image-fusion biopsy equipment as a network and obtaining a very competitive price for the NHS with a significant discount from list prices; with the RAPID sites set up as training hubs for other users.

- Broad spectrum data collection across a range of geographies to help establish a network and dataset for research

Whilst more men will undergo a non-invasive MRI, the overall anticipated (yet to be evaluated) reduction in costs associated with the pathway are due to a reduction in number of: - men biopsied - samples taken per biopsy due to higher accuracy - theatre and general anaesthetic slots due to change in biopsy technique