title: Can delayed time to referral to a tertiary level urologist with an abnormal PSA level affect subsequent Gleason grade in the opportunistically screened population?
abstract: OBJECTIVE
  There is growing conflict in the literature describing the effect of delayed treatment on outcomes following radical prostatectomy. There is also evidence to suggest progression of low-risk prostate cancer to develop higher grades and volumes of prostate cancer during active surveillance. It is unknown as to what affect a delay in referral of those men with abnormal screened-PSA levels have on subsequent Gleason grade.
  
  
  METHODS
  We identified 350 men through our rapid access prostate clinic who underwent TRUS biopsy for abnormal age-related PSA and/or abnormal clinical examination. Clinicopathological findings were compared for those with positive versus negative TRUS biopsies, and for those with initial delays in referral (<12 months, 12-18 months, and >18 months). We used ANOVA and Student's t-tests amongst other statistical tools to examine significance of clinical findings.
  
  
  RESULTS
  Of the 350 men who underwent TRUS biopsy, those with a delay in referral of 12 months or more were significantly associated with higher PSA titers, clinically palpable disease and likelihood of diagnosis with prostate cancer. A delay of 18 months or more led to a significantly higher risk of being diagnosed with a leading grade 4 prostate cancer, which was further supported using PSA velocity as a diagnostic tool (change >0.4 ng/ml/year).
  
  
  CONCLUSIONS
  We recommend that repeated asymptomatic abnormal age-related PSA readings and/or abnormal clinical examination in the screened population be referred without delay to a urologist for further assessment, enrolment into an active surveillance program or definitive subsequent treatment.
authors: Department of Urological Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland. fokelly@rcsi.ie
authors: Fardod
authors: F
authors: O'Kelly
authors: Arun
authors: A
authors: Thomas
authors: Denise
authors: D
authors: Murray
authors: David
authors: D
authors: Galvin
authors: David
authors: D
authors: Mulvin
authors: David M
authors: DM
authors: Quinlan
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010820:Physicians / Q000592:standards; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000096:biosynthesis* / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D012017:Referral and Consultation / Q000592:standards; D062606:Tertiary Care Centers / Q000592:standards; D013997:Time Factors; D014572:Urology / Q000379:methods / Q000592:standards
chemical_list: D017430:Prostate-Specific Antigen
keywords: Gleason grade; delay; progression; prostate cancer; prostatectomy; rapid access prostate clinic