Waiting the typical two to three weeks for the results of a prostate cancer biopsy can be agonizing for men and their families, but at least one Canadian hospital is trying to change that.
Sunnybrook Health Sciences Centre in Toronto has instituted a rapid results clinic that cuts the wait time for diagnosis for most patients to three days following a prostate biopsy.
It's not that the hospital has changed the way biopsy samples are scrutinized for tumours. Over the last three months, it has merely speeded up the process through more efficient use of its pathology department, which includes three pathologists who specialize in the finicky assessment of prostate tissue.
"So you get your answer within 72 hours, and not only that but to be able to be seen by a cancer specialist if you're diagnosed with cancer right away, right after the diagnosis, is I think a very efficient and unique process," said Dr. Robert Nam, a urologic oncologist at Sunnybrook.
Speeding up testing has not altered the accuracy of prostate biopsy results, nor has it affected other pathology tests, he noted.
"With the rapid biopsy clinic, it really improves patients' lives in terms of their level of anxiety," said Dr. Nam, recalling that when patients in the past were told they didn't have cancer after waiting two to three weeks, "the relief on their face was unbelievable."
Dr. Nam said he hopes rapid result biopsy clinics will be adopted by other hospitals and physicians across the country.
The hospital also employs an exacting method of determining whether a man needs a biopsy, based on a sophisticated risk assessment tool that mixes in results from standard PSA testing and a rectal exam. A rise in PSA, or prostate specific antigen, can indicate the presence of cancer in the walnut-sized gland, but the test by itself is by no means definitive.
The individual risk assessment tool is available online at www.prostaterisk.ca, and can be used as a starting point by a general practitioner to decide whether a patient should be referred to a specialist for further testing.
"We can identify those who really need a biopsy because they have a high risk for prostate cancer, and aggressive prostate cancer, which conventional PSA (testing alone) may miss," Dr. Nam said. "And on the flip side, we can avoid doing unnecessary invasive biopsies."
To perform a biopsy, a probe is inserted through the rectum, the prostate is frozen with a numbing agent, and between eight and 15 needles are inserted into the gland to capture tissue samples for testing.
But the procedure carries its own risks of complications, including infection, bleeding and urinary difficulty, Dr. Nam said. "We want to minimize that risk."
"With the calculator, we hope we can avoid biopsies in those who really don't need treatment," he said. "That's the key here - selective screening. We don't want to diagnose everybody on the street with prostate cancer. We want to be able to find the patients who really need a biopsy, where it's really important to treat them."
At a quick glance, Barry Shiffman wouldn't have seemed to be among those needing a biopsy. Just 44, he had no known family history of the disease and his regular PSA tests were normal, though his prostate had been slightly enlarged for some years.
But when he moved to Toronto last year from Alberta, a routine physical showed the violinist had an elevated PSA level. His physician sent him to Dr. Nam, who determined Mr. Shiffman had enough risk factors to justify a biopsy, which he had in mid-February.
"Three days later we had the results," said Mr. Shiffman, acknowledging he was shocked to learn he had cancer. "I felt terrified and still do feel terrified about my diagnosis - I am only in my 40s - but I feel good to know they caught it early and that I won't be in a worse situation."
Mr. Shiffman, who is scheduled to have his prostate gland removed April 8, said he was relieved to have had the diagnosis so quickly following the biopsy.
"Had the prostate cancer been found at a later stage, it would have been less treatable," said the married father of two young daughters, who performs on stages around the world. "I'm looking forward to a new normal and getting fully back to my family and my professional life."
Dr. Nam said fine-tuning individual risk to better pinpoint who should have a biopsy - then getting the results quickly - can mean putting a dent in mortality from prostate cancer, which last year claimed the lives of about 4,300 Canadian men.
"When we see them, it's a snapshot of a person's life. We don't know where they are in the curve of tumour growth," he said. "Even a delay of two or three weeks could affect the natural history of the tumour. They could be on the cusp of the cancer growing and metastasizing.
"I think what we are doing is going to revolutionize how we detect and screen for prostate cancer," Dr. Nam said.
The Canadian Press