One Stop Prostate Biopsy Protocol Author Consultation Date Approved

Transcription

1 One Stop Prostate Biopsy Protocol Author Consultation Date Approved Urology Nurse Practioner

2 PROTOCOL FOR MEN ATTENDING A ONE STOP PROSTATE BIOPSY CLINIC RATIONALE Prostate cancer is the most common cancer in men in the united kingdom and accounts for 24% of all new male cancers. This equates to approximately 37,000 new cases being diagnosed annually. There are currently three commonly used procedures to diagnose prostate cancer; digital rectal examination (DRE), the PSA blood test and trans rectal ultrasound scan (TRUS) and needle biopsy. DRE & PSA combined, increases the predictive value of prostate cancer, and are therefore considered essential before proceeding with biopsies. PURPOSE The aim of the protocol is to provide the urology nurse with clear guidelines for the assessment and investigation of patients suspected of having prostate cancer. In addition to this it aids with: Streamlining the patient pathway Reduce waiting times Compliance of government targets Cost effectiveness SCOPE The protocol is aimed at patients that have had an initial assessment with a healthcare professional and have been deemed as suspected of having prostate cancer by them, as set out in NICE referral guidelines for suspected cancer ( 2005). PROTOCOL DETAILS The urology nurse responsible for co coordinating the management of these patients will be an experienced urological nurse practitioner. The nurse must

3 be competent to assess and make decisions independently when required, or after consultation with the urological consultant. The nurse practitioner will have in depth knowledge and be deemed competent by a designated mentor in: Signs & Symptoms of prostate cancer History taking Interpretation of the physical examination, history taking and initial investigations that have been carried out Risk factors Consent Prostate biopsy procedure Further investigations Treatments available: o Watchful Waiting o Active Surveillance o Radical Prostatectomy o Radiotherapy o Brachytherapy o Hormonal therapy Interpretation of histopathological prostate biopsy reports REFERRALS Patients can be referred via GP s, Practice Nurses, and secondary care Consultants. All referrals are to be screened by a Consultant, Associate Specialist or Urology Nurse Practitioner EXCLUSION CRITERIA FOR A ONE STOP PROSTATE BIOPSY One elevated PSA No MSU Severe Morbidity > 75 years

4 Patient taking Anticoagulants Previous negative prostate biopsies All aspects of the Nurse led part of the one stop prostate biopsy clinic are protocol led and have been established in accordance with NICE Prostate Cancer: diagnosis and treatment (2008) and approved by all the Urology Consultants at Cwm Taf LHB. Any deviations that may arise outside of the protocol should be discussed with the individual Consultant that the patient is under the care of.

5 REFERENCES National Institute for Health and Clinical Excellence (2008) Prostate Cancer: diagnosis and treatment full guideline National Collaborating Centre for Cancer: Wales National Institute for Health and Clinical Excellence (2005) Referral Guidelines for Suspected Cancer National Collaborating Centre for Cancer

6 Patient Pathway Referral to Appointment 1. Referral received and date stamped by urology secretaries 2. Referral screened: a. More clinical information required i. Letter sent to referring GP and patient b. Listed for one stop prostate biopsy clinic i. Referral given to 1 st appointments with clinic date & time ii. X ray informed of date & time c. Listed for outpatient elevated PSA clinic i. Referral given to 1 st appointments with OP clinic date 3. Appointment sent out by 1 st appointments to the patient including information re: a. PSA testing b. The biopsy procedure c. Contact number of the nurse practitioner Administration for the patients identified as being suitable to attend the one stop prostate biopsy clinic 1. Notes requested from medical records as soon as referral reviewed 2. Notes reviewed to confirm suitability 3. Patient information entered onto the one stop prostate biopsy database 4. X ray informed if any patient identified is not suitable 5. Prescription for patient completed for prophylactic antibiotics and taken to pharmacy 6. Prescriptions delivered to urology nurse practitioner Prostate Biopsy Clinic 1. Patient attends the outpatient department and is reviewed by the nurse practitioner in clinic. Proforma completed. The review will include obtaining a / and providing: a. Reason for referral b. Clinical History

7 c. Clinical examination d. +/- flow rate and post void residual e. Adverse effects of biopsies f. Consent g. FU options discussed i. FU in clinic ii. Telephone FU with urology nurse practitioner h. Antibiotic cover given 2. Patient taken to the X ray department for the procedure 3. Patient is received by radiology staff: a. Observations checked b. Consent checked 4. Patient taken into prostate biopsy suite 5. Prostate biopsy performed 6. Notes written in by Consultant and any complications documented. 7. Patient taken to recovery area a. Observations checked b. Pain level assessed c. Urine voided, checked for haematuria and recorded 8. Patient discharged home with: a. Contact helpline numbers b. Post biopsy information sheet c. Discharge summary for GP d. Remaining prophylactic antibiotics 9. Samples taken to pathology department 10. Notes returned to Urology 11. Letter dictated by urology nurse practitioner for typing by urology secretary

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