Wolfs, A.P.J. (Lotte) (2021) Ultrasound-based risk calculation and selection for MRIprostate in patients at risk for prostate cancer in a GP practice: A prospective single-centre study. thesis, Medicine.
Full text available on request.Abstract
Background: Dutch general practitioners (GPs) refer, based on their guidelines, men with prostate-specific antigen (PSA) level ≥3.0 ng/ml to the hospital. Until recently, prostate biopsies were performed directly. However, since 2019 the European guideline states that an MRI-scan as well as risk-based selection using a risk calculator like the Rotterdam Prostate Cancer Risk Calculator (RPCRC) must be performed in advance to decide upon performing prostate biopsies. Therefore, the number of MRI-scans has increased enormously. Using the RPCRC in a primary care setting could improve efficiency of the clinical pathway even further by preventing unnecessary referrals and MRI-scans. Objective: To assess the efficiency of ultrasound-based risk calculation and selection for MRIprostate in patients at risk for prostate cancer (PCa) in a primary care setting and to perform a cost-analysis of implementing transrectal ultrasound (TRUS) in primary care. Methods: This prospective single-centre study (September 2020-January 2021) was initiated in collaboration with ten GP practices in the Utrecht-Nieuwegein area. GPs referred patients at risk for PCa for TRUS examination and risk calculation in a primary care setting. Patients were being advised on referral to secondary care based on the RPCRC results (high-risk ≥ 12.5%). All patients signed informed consent. Results: A total of 32 men, median age 71 years [interquartile range (IQR), 64-75] and median PSA level 4.8 ng/ml [IQR, 3.7-6.7] were included. After ultrasound-based risk calculation, 20 (62%) patients were considered high-risk (≥12.5%) and were referred to secondary care for further diagnostic examination by means of an MRI-scan. PI-RADS score ≥3 was found in eight (40%) patients. Prostate biopsies were performed in five (25%) patients and PCa was detected in all of these patients [4/5 (80%) had Gleason score (GS) ≥ 3+4 =7 PCa]. This new diagnostic pathway provides an average cost reduction of €86-115 per patient. Conclusion: Ultrasound-based risk calculation and selection for MRI-prostate in a primary health care setting is an efficient diagnostic pathway. It prevents 38% of referrals to secondary care in men at risk for PCa. Health care costs are reduced substantially. More research with larger sample sizes and follow-up data is needed to validate these results.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Cremers, Dr. R.G.H.M. and Melick, Dr. H.H.E. van |
| Faculty: | Medical Sciences |
| Date Deposited: | 24 Dec 2021 08:36 |
| Last Modified: | 24 Dec 2021 08:36 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2904 |
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