MEN'S HEALTH MATTERS:What happens at the new rapid access prostate cancer diagnosis clinics, writes THOMAS LYNCH.
Q There was a lot of publicity last week about new rapid access prostate cancer clinics for men. Can you please explain what these clinics are and how do they work? Can you explain how a prostate biopsy is performed?
ATwo of the eight cancer centres (St James's Hospital, Dublin and Galway University Hospital) have recently opened Rapid Access Diagnostic Clinics for men who are worried that they might have prostate cancer.
These two clinics are being run on a pilot basis and the National Cancer Control Programme (NCCP), headed by Prof Tom Keane, plans to support the other centres in developing and opening clinics within the next 12 months.
These Rapid Access Prostate Diagnostic Clinics will enable men to be seen quickly by medical teams to ensure a speedy diagnosis.
About 2,400 men develop prostate cancer in Ireland annually, and about 550 men die from it each year. The current pathway for the diagnosis of prostate cancer is through referral of patients who are suspected of having prostate cancer to general urology clinics which can lead to unacceptable delays in diagnosis.
These new clinics fast track patients and allow a definitive diagnosis to be established more quickly.
Patients will be referred by their general practitioner and be offered an appointment to be seen at the one-stop clinic within two weeks. They will be assessed by a urologist and needle biopsies of the prostate will be performed as appropriate at this first visit.
The patients will then have their results within two weeks of the biopsy. Further management will be decided by a multidisciplinary team, which includes consultants with an expertise in prostate cancer.
As well as speeding up assessment of patients and allowing for an earlier definitive diagnosis, the rapid access clinics will also speed up decision-making for patients who are diagnosed with prostate cancer.
No special preparation is required prior to a prostate biopsy and you do not need to fast. Initially you will be given antibiotics to help prevent infection because the procedure is done through the back passage. You will then be asked to lie on your side.
The ultrasound instrument is placed into the back passage, in a similar way that a doctor examines the prostate with a finger. This transrectal ultrasound probe enables the doctor to see deep into the prostate, perhaps revealing abnormal areas that are difficult to find by digital rectal examination.
You will then be given a local anaesthetic and a fine biopsy needle is guided with the help of the ultrasound probe and multiple biopsies are taken.
The entire procedure takes less than 15 minutes and may be a little uncomfortable but is not usually painful. You will be kept fully informed throughout the procedure. In general, this is a very safe procedure and most people have no trouble.
Occasionally after a biopsy some bleeding will occur. There may be blood in the urine, mixed with the sperm or blood on the bowel motions. If this occurs, it usually settles after a day or two and increased fluid intake helps. You may also experience some mild transient difficulty passing urine.
The development of these clinics marks a very important step towards creating a disease-specific approach for the diagnosis and treatment of men with prostate cancer, a service which has been available for women with breast cancer for some years.
The capital funding to establish the first two clinics was provided by The All Ireland Cancer Foundation (AICF), an organisation which brings together cancer specialists and business people from both sides of the Border to improve the knowledge and treatment of cancer in both jurisdictions.
The establishment of these clinics has been made possible by donations from Denis O’Brien and Leslie Buckley.
Rapid access to diagnostic facilities for men who are at risk of, or suspected of, having prostate cancer should be the norm. There is evidence of substantial variation across the State in wait times to diagnose prostate cancer and the National Cancer Control Programme’s plan to develop these new clinics in the cancer centres should address this.
All of these clinics will be run within national guidelines so there should be no variation between the centres in wait times and outcomes for men with prostate cancer.
It must be remembered that about 75 per cent of patients attending for prostate biopsy will be shown not to have a cancer. This group of patients are the worried well and this rapid access facility will shorten their period of anxiety while waiting for results. The launch of the first two clinics in Galway and St James’s hospitals is a very exciting start to the roll out of this national project.
This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin
