The PRAGMATIC pathway - PRostate cancer diAGnosis and MAnagement Triage In Clinical care.

[OBJECTIVES] To investigate whether nurse navigator-led triaging of high-risk patients may reduce prostate cancer (PCa) diagnosis and treatment times using an in-house bespoke PRostate cancer diAGnosis and MAnagement Triage In the Clinial care pathway (PRAGMATIC) triaging system, as locally advanced/metastatic disease should be diagnosed and treated rapidly, and UK targets allow 28 days for diagnosis, and 62 days to commence treatment.

[PATIENTS AND METHODS] We reviewed diagnosis and treatment timelines for patients undergoing 28/62-day investigation for suspected PCa at a tertiary unit in a 3-month period (2022). We then introduced nurse navigator-led triaging of urgent referrals and evaluated a subsequent 3-month period (2024), with streamlining for rapid investigation and treatment based on prostate-specific antigen, magnetic resonance imaging (MRI) staging, and histology. We hypothesised nurse navigator-led triaging would improve investigation and treatment times for high-risk localised, or locally advanced, or metastatic PCa.

[RESULTS] A total of 165 and 327 consecutive patients were on the 28/62-day PCa pathway in the pre- (2022) and post-nurse navigator-led (2024) triaging periods, respectively. The median time from referral to first appointment (8 vs 4 days), MRI (12 vs 6 days), MRI result (26 vs 17 days), biopsy decision (25 vs 16 days), biopsy procedure (48 vs 22 days), biopsy result communication (64 vs 44 fays), and prostate-specific membrane antigen positron emission tomography computed tomography staging scan (87 vs 56 days) was reduced following nurse navigator triaging of high-risk cases (all P < 0.001). The median time from referral to treatment for Gleason Grade Group ≥3, or T3, or ≥N1, or ≥M1 disease (104 vs 70 days; 49/75 [65.3%] vs 72/128 [56.3%] patients), and for M1b disease (47 vs 27 days; 15/75 [20%] vs 32/128 [25%] patients), was reduced (P < 0.05).

[CONCLUSIONS] Nurse navigator-led triaging and stratification of the most clinically urgent suspected PCa cases was associated with improved imaging, biopsy diagnosis, and treatment times for the highest-risk patients.