title: Emerging evidence for Gleason grade migration and distance impact in prostate cancer? An analysis of the rapid access prostate clinic in a tertiary referral center: St. Vincent's University Hospital, Dublin (2009-2011).
abstract: BACKGROUND
  Recent evidence has suggested that the introduction of rapid access prostate cancer programs has led to a more streamlined pathway for patients, and was designed to ultimately reduce referral delays.
  
  
  OBJECTIVE
  To identify the initial impact of the introduction of the rapid access prostate clinic on Gleason grading within the prostate cancer cohort, as well as the impact of distance from a tertiary referral center on subsequent Gleason grading.
  
  
  METHODS
  A prospective database was maintained from those men attended the rapid access prostate clinic in St. Vincent's University Hospital. Data relating to demographics, biopsy results, retrospective PSA readings, and subsequent treatment pathways were all recorded and analyzed. Statistical significance was taken at p<0.05.
  
  
  RESULTS
  Prospective data from the rapid access prostate clinic illustrated similar results in patient demographics, Gleason grade and choice of treatment outcomes to other published institutions, however, for the first time demonstrate emerging evidence of the effect of the rapid access prostate clinic leading to a downward shift in Gleason grade over a 2-year period, as well as data showing an inverse correlation between leading Gleason grade and distance from our tertiary referral center.
  
  
  CONCLUSIONS
  These results suggest that the introduction of the rapid access prostate clinic has initially begun to demonstrate an initial downgrading in Gleason scoring patterns. Our data also reflects a poorer Gleason score in those patients living further away from the rapid access prostate clinic. This may be in part attributed to a surge in referrals of those patients previously managed outside a tertiary institution, and suggests that patients should undergo prompt referral following suspicion for prostate cancer.
authors: Department of Urological Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4. fokelly@rcsi.ie
authors: F
authors: F
authors: O'Kelly
authors: A Z
authors: AZ
authors: Thomas
authors: D
authors: D
authors: Murray
authors: P
authors: P
authors: Lee
authors: R F
authors: RF
authors: O'Carroll
authors: P
authors: P
authors: Nicholson
authors: H
authors: H
authors: Forristal
authors: N
authors: N
authors: Swan
authors: D
authors: D
authors: Galvin
authors: D
authors: D
authors: Mulvin
authors: D M
authors: DM
authors: Quinlan
mesh_terms: D000328:Adult; D000368:Aged; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000145:classification* / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D012017:Referral and Consultation; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome