18 Transforming the prostate cancer pathway by incorporating same-day multiparametric prostate mri (mpmri) scans and prostate biopsies – prompt diagnosis with improved cancer waiting times

Aims Prostate cancer diagnosis clinics traditionally utilise clinical examination, PSA test and prostate biopsy. Increasing evidence suggests pre-biopsy prostate mpMRI enables targeting of lesions or avoidance of biopsy altogether. However, incorporating mpMRI into the pathway challenges compliance with national cancer targets (NCTs). Our aim was to create a high quality prostate diagnostic pathway with same day mpMRI and prostate biopsies, enabling efficient prostate cancer diagnosis and treatment. Methods Retrospective analysis of key performance metrics (waiting times) in 318 referrals was undertaken prior to (2014), during (April – May 2016), and after (July – Nov 2016) implementation of the pathway. The overall impact on the 62 days NCT pathway compliance was assessed. Results All key metrics significantly improved following implementation of the changes. The mean waiting times for GP referral to 1 st clinic (11, 13, 8 days); 1 st clinic to mpMRI (17, 5, 1 days); and 1 st clinic to biopsies (22, 18, 8 days) for pre-, during and post pathway implementation, respectively. Post-implementation 72% patients were reviewed the same day with mpMRI results and given a definitive plan: biopsy, PSA surveillance or discharge. Prompt mpMRI and same day review also allowed 28% of referrals to be discharged or put on PSA follow-up, constituting a “clock-stop” on their pathway. Pathway compliance on 62 day metric was near 100% on the new pathway. The total cost per MRI/biopsy patient is -£661 on the new pathway (2016 HRG codes); compared to the historical cohort this was at least cost neutral as it only involved efficient re-organisation of pre-existing practice. Conclusions Providing and maintaining a robust and timely prostate cancer pathway catering to a large patient population is both feasible and rewarding. This requires a multi-disciplinary team approach without any additional funding at sites where mpMRI is already a part of the prostate diagnostic work up.