The initial results after one year of the Prostate Consultation, a collaboration between the NKI Center for Early Diagnostics and SALT, are promising. These results show that the Prostate Consultation is a valuable addition to primary care and that early detection can be implemented safely and efficiently.
The Prostate Consultation
The Prostate Consultation, conducted at SALT in Zaandam, aims to provide an additional assessment of prostate cancer risk in men with slightly elevated PSA levels, allowing them to avoid unnecessary referrals to secondary care. This collaboration is part of the P-GUIDE project, funded by KWF Dutch Cancer Society.*
Facts & figures after a year
300 men have been referred to the Prostate Consultation in its first year:
-
The average age at referral was 69 years
-
The average PSA level was 8.5 ng/ml
-
76% of men were able to avoid a referral to secondary care
-
1 in 5 men was advised to stop screening due to age or comorbidities
-
53% were advised to repeat the PSA test only after at least two years, provided there was a desire for early detection and a good life expectancy
What is the Prostate Consultation?
The Prostate Consultation is intended for men aged 50–75 with a PSA level between 3.0 and 10.0 ng/ml who do not have symptoms suggesting prostate cancer. During the consultation, a prostate ultrasound and a digital rectal exam are performed. The results are combined with the PSA value using the predictive model ‘Prostaatwijzer’, giving the GP an accurate risk assessment for (significant) prostate cancer.
The collaboration between SALT and the NKI is considered “one-and-a-half line” care: the patient is seen at SALT, but the GP remains their practicing physician. The consultation takes place at SALT’s Medisch Centrum De Vaart location in Zaandam. If the Prostate Consultation indicates an increased risk of prostate cancer, the patient is referred via his GP to the regional hospital.
Urologist Pim van Leeuwen from the Antoni van Leeuwenhoek Hospital emphasizes the benefits of this approach: “Previous research showed that using the Prostaatwijzer in primary care can reduce referrals by 68%. The Prostate Consultation provides a patient-friendly way to lower healthcare costs, waiting times, and workload.”
The importance of early detection
Prostate cancer is the second most common cause of cancer-related death among men in the Netherlands, secondary only to lung cancer. In 2022, over 3,000 men died from the disease. Prostate cancer is often diagnosed only after it has metastasized, when treatment options are limited. As there is currently no national prostate cancer screening program in the Netherlands, early detection in general practice plays a crucial role.
With the new GP guideline on prostate cancer, men without symptoms can now choose early detection via PSA testing. This will further increase the demand for reliable risk assessment.
*P-GUIDE is a multidisciplinary collaboration aimed at improving secondary prevention of prostate cancer and all steps in individual decision-making in the diagnostic care pathway for men aged 50–75 with an increased risk of clinically significant prostate cancer.
