MULTIVARIABLE RISK-STRATIFICATION IN A PRIMARY HEALTHCARE SETTING: REFERRAL RATE AND BIOPSY RESULTS FROM A UROLOGY OUTPATIENT CENTER.

You have accessJournal of UrologyProstate Cancer: Detection & Screening II1 Apr 2018PD23-09 MULTIVARIABLE RISK-STRATIFICATION IN A PRIMARY HEALTHCARE SETTING: REFERRAL RATE AND BIOPSY RESULTS FROM A UROLOGY OUTPATIENT CENTER. Daniël Osses, Arnout Alberts, Gonny Bausch, and Monique Roobol Daniël OssesDaniël Osses More articles by this author , Arnout AlbertsArnout Alberts More articles by this author , Gonny BauschGonny Bausch More articles by this author , and Monique RoobolMonique Roobol More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1190AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of multivariable risk-stratification in primary care could optimize the diagnostic pathway by reducing unnecessary referrals to specialist care. Dutch primary care physicians (PCPs) refer men with prostate-specific antigen (PSA) level ≥3.0 ng/ml to the urologist for risk-based patient selection for prostate biopsy using the Rotterdam Prostate Cancer Risk Calculator (RPCRC). Here, we calculated the risk and assessed the rate of men referred to the urologist with PSA level ≥3.0 ng/ml by implementing the RPCRC in a primary care setting. METHODS PCPs were given the possibility to refer men with a suspicion of prostate cancer (PCa) or screening wish to a primary care clinic (STAR-SHL) where further assessment including next to PSA, digital rectal examination and transrectal ultrasound with prostate volume measurement was performed by specially trained personnel. Risk-based advice on referral to the urologist was given to the PCP on the basis of the RPCRC results (lower part Table 1). If requested, advice on treatment of lower urinary tract symptoms (LUTS) was given. All men signed informed consent. RESULTS Between January 2014 and September 2017 a total of 243 men, median age 64 yr (range 39-91) were referred by their PCP for a consultation at the primary care clinic. Of 108 men with PSA level ≥3.0 ng/ml and a referral related to PCa, PCPs were advised to refer 58 men to the urologist (54%) (Table 1). Of the men with available follow-up (FU) (N=187, median FU 16 months; range 1-37) 54 men (8 men PSA <3.0 and 46 men PSA ≥3.0) were considered high-risk. Of these men 51 (94%) men were actually referred to specialist care by their PCP and so far 38 men underwent biopsy. PCa was detected in 30 men (47% had Gleason score [GS] ≥3+4 PCa), translating into an overall positive predictive value of 79%. Within the available FU time 2 of 38 (5%) men with PSA level ≥3.0 ng/ml considered low-risk have been diagnosed with GS 3+3 PCa. CONCLUSIONS Use of the RPCRC in a primary healthcare setting could prevent almost half of referrals of men with PSA level ≥3.0 ng/ml to the urologist. In more than three-quarter of men referred for prostate biopsy, the suspicion of PCa was confirmed. These data show huge potential for multivariable risk-stratification in primary care. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e483 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Daniël Osses More articles by this author Arnout Alberts More articles by this author Gonny Bausch More articles by this author Monique Roobol More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...