title: The effect of Rapid Access Prostate Clinics on the outcomes of Gleason 7 prostate cancer: does earlier diagnosis lead to better outcomes?
abstract: BACKGROUND
  Rapid Access Prostate Clinics (RAPC) were introduced in Ireland by the National Cancer Control Programme bringing about expedited referral pathways and increased detection rates of prostate cancer. Lower Gleason (G) grade at diagnosis due to RAPC has been previously reported but grade at prostatectomy has not been assessed. The aim of this study was to assess the impact of RAPC on the outcomes of patients with G7 disease on radical prostatectomy (RP).
  
  
  METHODS
  A retrospective analysis was carried out of all RPs performed over a 9-year period (2006-2014). Outcomes for G7 prostatectomies were compared before and after the introduction of the RAPC, with a further sub-analysis of G4 + 3 versus G3 + 4. The primary outcome was biochemical recurrence (BCR). Other outcomes were adjuvant/salvage radiotherapy, extra prostatic extension, positive surgical margins, seminal vesicle involvement and tumour stage.
  
  
  RESULTS
  In total, 240 RPs were performed with 167 cases graded G7 (70 graded G4 + 3 and 97 graded G3 + 4). Since the introduction of RAPC the proportion of G4 + 3 compared to G3 + 4 has increased from 37.9 to 42%. There was no statistical difference in outcomes for G4 + 3 treated before and after the introduction of RAPC. G4 + 3 was associated with higher rates of BCR (24.4 vs. 0%, p < 0.0001, radiotherapy (41.1 vs. 4.8%, p < 0.0001) and worse histological features than G3 + 4.
  
  
  CONCLUSIONS
  Despite the benefits in diagnosis of prostate cancer brought about by RAPC in Ireland, this has not translated to a lower grade for surgically treated patients. There has been no improvement in outcomes especially for higher grade G4 + 3 disease.
authors.affiliation: Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland. markbroe@rcsi.ie.
authors.forename: M P
authors.initials: MP
authors.lastname: Broe
authors.affiliation: Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: J C
authors.initials: JC
authors.lastname: Forde
authors.affiliation: Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: M S
authors.initials: MS
authors.lastname: Inder
authors.affiliation: Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: D J
authors.initials: DJ
authors.lastname: Galvin
authors.affiliation: Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: D W
authors.initials: DW
authors.lastname: Mulvin
authors.affiliation: Department of Urology, St. Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: D M
authors.initials: DM
authors.lastname: Quinlan
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units / Q000592:standards*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Biochemical recurrence; Gleason 3+4; Gleason 4+3; Gleason 7; Prostate cancer; Rapid Access Prostate Clinics