A sustainable and expedited ‘One-Stop’ prostate cancer diagnostic pathway to reduce environmental impact and enhance accessibility

Objective

To assess the carbon footprint, accessibility, and diagnostic performance of an expedited ‘One-Stop’ prostate cancer (PCa) diagnostic pathway.

Materials and methods

A total of 1083 consecutive patients undergoing magnetic resonance imaging (MRI) followed by transrectal ultrasound fusion-guided prostate biopsy (PBx) were identified from a prospective database. The patients were divided according to the diagnostic pathway: One-Stop, with MRI and same-day PBx (3 hours apart), or Standard, with MRI followed by a second visit for PBx. Socioeconomic status was evaluated by the Distressed Communities Index (DCI) and the carbon footprint by the United States (U.S.) Environmental Protection Agency Greenhouse Gases Equivalencies Calculator.

Results

Overall, 260 patients underwent the One-Stop and 823 the Standard pathway. The One-Stop patients lived farther from the hospital (163 vs. 23 km; p < 0.001), had lower socioeconomic status with DCI scores of 49 versus 30 (p < 0.001), and were more likely to be Latinos (21% vs. 13%, p < 0.001) compared to the Standard patients, respectively. The One-Stop saved 69 575 km in round trips, over 16 tons of travel-related CO₂ emissions, and $8214 U.S. dollars. For patients with Prostate Imaging Reporting & Data System (PIRADS) 3–5, the clinically significant PCa detection (53% vs. 50%, p = 0.55) was similar for the One-Stop and Standard pathways, respectively.

Conclusions

The One-Stop PCa diagnostic pathway reduces carbon footprint, distance travelled, and patient-level cost while maintaining clinical outcomes comparable to the Standard pathway. It facilitates access to tertiary-level care for minorities and underserved populations.