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Suspected P rostate Cancer Best Timed Pathway (BTP) Susan Todd Project Manager

Greater Manchester Cancer. Suspected P rostate Cancer Best Timed Pathway (BTP) Susan Todd Project Manager. Urology Cancer Update for Primary Care 29 June 2019. susan.todd7@nhs.net. Greater Manchester Cancer. NHSE Prostate BTP. Greater Manchester Cancer. NHSE Prostate BTP.

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Suspected P rostate Cancer Best Timed Pathway (BTP) Susan Todd Project Manager

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  1. Greater Manchester Cancer Suspected Prostate Cancer Best Timed Pathway (BTP)Susan ToddProject Manager Urology Cancer Update for Primary Care 29 June 2019 susan.todd7@nhs.net

  2. Greater Manchester Cancer NHSE Prostate BTP

  3. Greater Manchester Cancer NHSE Prostate BTP

  4. Greater Manchester Cancer Patient Information

  5. Greater Manchester Cancer Prostate BTP 1. Locally mandated information is determined with commissioners but should include demographics, investigation results (PSA, U&E/ eGFR, 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 >3ng/ml should be used as referral rate for men aged 50-69. A rectal swab may also be required.

  6. Greater Manchester Cancer Suspected Cancer Referral

  7. Greater Manchester Cancer Suspected Cancer Referral - eGFR

  8. Greater Manchester Cancer Q. Why is eGFR required? A. Because the multi-parametric MRI includes contrast enhanced sequences • ESUR/RCR guidelines • Advise caution in patients with eGFR <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 (eGFR <15ml/min) is 0.1-1%

  9. Greater Manchester Cancer In many cases the DCE adds significant confidence - the ADC is grainy and difficult to interpret T2 B 1000 ADC DCE

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

  11. Greater Manchester Cancer Telephone Triage

  12. Greater Manchester Cancer • Referral forms: Dr Sarah Taylor, Primary Care GM Cancer Lead and Macmillan GP, sltaylor@nhs.net • Patient information sheet: susan.todd7@nhs.net • NHSE Prostate pathway: https://www.england.nhs.uk/wp-content/uploads/2018/04/implementing-timed-prostate-cancer-diagnostic-pathway.pdf • GatewayC

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