Greater Manchester Cancer Suspected Prostate Cancer Best Timed

Greater Manchester Cancer Suspected Prostate Cancer Best Timed Pathway (BTP) Susan Todd Project Manager susan. todd 7@nhs. net Urology Cancer Update for Primary Care 29 June 2019

Greater Manchester Cancer NHSE Prostate BTP

Greater Manchester Cancer Patient Information

Greater Manchester Cancer Prostate BTP 1. Locally mandated information is determined with commissioners but should include demographics, investigation results (PSA, U&E/ e. GFR, urine dipstick (+ MSU result if dipstick positive), and DRE), performance status, weight and BMI, medication, anti-coagulant history, and MRI scanning exclusion criteria. A PSA of >3 ng/ml should be used as referral rate for men aged 50 -69. A rectal swab may also be required.

Greater Manchester Cancer Suspected Cancer Referral

Greater Manchester Cancer Suspected Cancer Referral - e. GFR

Greater Manchester Cancer Q. Why is e. GFR required? A. Because the multi-parametric MRI includes contrast enhanced sequences § ESUR/RCR guidelines § Advise caution in patients with e. GFR <30 ml/min § Main risk of Gadolinium-based contrast agents is nephrogenic systemic fibrosis (NSF) • Develops from day of exposure to 2/3 months • Early changes: pain, pruritis, swelling and erythema usually starting in legs, can progress to fibrosis and limb contractures, fibrosis of internal organs, death § Incidence in severe renal failure (e. GFR <15 ml/min) is 0. 1 -1%

Greater Manchester Cancer In many cases the DCE adds significant confidence - the ADC is grainy and difficult to interpret T 2 B 1000 ADC DCE

Greater Manchester Cancer Prostate BTP: e. GFR § Optimal MRI scan (mp. MRI) within 7 days, the e. GFR needs to be known before the scan date § Consider the U&E box when requesting PSA blood test (before decision to refer for suspected cancer) § No e. GFR, no DCE, no scan, delay to patient § Patient can have the contrast agent (if e. GFR more than 30 ml/min) § DCE: § Greater confidence cancer/no cancer § numbers patients having prostate biopsy § Some patients informed swiftly of no cancer

Greater Manchester Cancer Telephone Triage

Greater Manchester Cancer § Referral forms: Dr Sarah Taylor, Primary Care GM Cancer Lead and Macmillan GP, sltaylor@nhs. net § Patient information sheet: susan. todd 7@nhs. net § NHSE Prostate pathway: https: //www. england. nhs. uk/wpcontent/uploads/2018/04/implementing-timed-prostate-cancerdiagnostic-pathway. pdf § Gateway. C