Waiting times for prostate cancer diagnosis in KwaZulu-Natal, South Africa

Aim: To study the efficacy and impact of the local pre-biopsy multiparametric magnetic resonance imaging (mpMRI) pathway for prostate cancer diagnosis. Methods: In this tertiary centre, 570 patients had prostate mpMRI across a 6-month period in 2019. A total of 511 patients met inclusion criteria for retrospective analysis. MRI reporting used the Prostate Imaging-Reporting and Data System (PI-RADS) v2.1. These were assessed alongside histological outcomes and diagnostic times. PI-RADS ⩾ 3 were recommended for biopsy consideration. Gleason scoring ⩾ 3 + 4 and 3 + 3 were used to define clinically and non-clinically significant prostate cancer (csPCa and nsPCa), respectively. Results: Overall prostate cancer prevalence was 40% (204/511, csPCa in 31.1%) with an overall biopsy avoidance of 32.1% (164/511). Around 69.7% (356/511) scored PI-RADS ⩾ 3 and 30.3% (155/511) scored PI-RADS 1–2. About 22.6% (35/155) of PI-RADS 1–2 patients proceeded to biopsy, demonstrating a negative predictive value of 91.43% for csPCa. For PI-RADS ⩾ 3 patients, 63.4% (197/312) of those biopsied had cancer (Gleason ⩾ 3 + 3), with 50% (156/312) demonstrating csPCa. Around 76.7% (102/133) of PI-RADS 5, 35.3% (48/136) of PI-RADS 4, 14.0% (6/43) of PI-RADS 3 and 8.6% (3/35) of PI-RADS 1–2 scores demonstrated csPCa. Overall median prostate-specific antigen (PSA) density was 0.15 ng/mL2 (IQR: 0.10–0.27/mL2). PSA density were significantly different across PI-RADS cohorts ( H = 118.8, p < 0.0001) and across all three biopsy outcomes ( H = 99.72, p < 0.0001). Only 34.3% (119/347) of biopsied patients met the NHS 28-day standard. MRI acquisition and reporting met the 14-day local standard in 96.1% (491/511). The biopsy was the most delayed component with a median of 20 days (IQR: 8–43). Conclusion: Pre-biopsy mpMRI with PI-RADS scoring safely avoided biopsy in almost one-third (32.1%) of patients. The use of PSA-density in risk stratifying PI-RADS 3 lesions has informed local practice in the period 2020–2021, with implementation of a PSA-density threshold of 0.12 ng/mL2. Biopsy scheduling issues and anaesthetic requirements need to be overcome to improve diagnostic waiting times. Level of evidence: 2

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Waiting Times for Prostate Cancer Diagnosis in a Nigerian Population

Journal of Cancer Epidemiology ◽

10.1155/2021/5534683 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Olufunmilade A. Omisanjo ◽

Olawale O. Ogunremi ◽

Olufemi O. Akinola ◽

Olaolu O. Adebayo ◽

Olufemi Ojewuyi ◽

...

Keyword(s):

Prostate Cancer ◽

Teaching Hospital ◽

Cancer Diagnosis ◽

Waiting Time ◽

Prostate Biopsy ◽

Waiting Times ◽

Prostate Cancer Diagnosis ◽

Nigerian Population ◽

The Mean ◽

Patient Presentation

Background. Prostate biopsy remains an important surgical procedure in the diagnostic pathway for prostate cancer, but access to prostate biopsy service is poorly studied in the Nigerian population. While there has been a well-documented delay in patient presentation with prostate cancer in Nigeria, little is however known about how long patients wait to have a histological diagnosis of prostate cancer and start treatment after presenting at Nigerian hospitals. Method. This was a descriptive retrospective study to document the specific duration of the various timelines in getting a diagnosis of prostate cancer at the Lagos State University Teaching Hospital, Ikeja, Nigeria. Results. There were 270 patients. The mean age was 69.50 ± 8.03 years (range 45-90). The mean PSA at presentation was 563.2 ± 1879.2 ng / ml (range 2.05-15400), and the median PSA was 49.3 ng/ml. The median waiting times were (i) 10 days from referral to presentation; (ii) 30 days from presentation to biopsy; (iii) 24 days from biopsy to review of histology; (iv) 1 day from histology review to discussion/planning of treatment. The median overall waiting time from referral to treatment was 103 days. The mean time from presentation to biopsy was significantly shorter for patients with PSA of ≥50 ng/ml compared to those with PSA < 50 ng / ml . p = 0.048 . Overall, the median time from biopsy to histology was significantly shorter for patients whose specimens were processed in private laboratories (17 days) compared to those whose specimens were processed at the teaching hospital laboratory (30 days), p ≤ 0.001 . Conclusion. There is a significant delay within the health care system in getting a prostate cancer diagnosis in the Nigerian population studied. The major points of the identified delay were the waiting time from patient presentation to having a biopsy done and the histology report waiting time.

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