Delays in prostate cancer diagnostic evaluation negatively impact patient experience and may adversely affect oncologic outcomes. We evaluated the impact of a telehealth-based Rapid Access Program (RAP) for men referred with elevated prostate-specific antigen (PSA) on diagnostic timeliness and patient access.
We implemented an advanced practice provider-led, telehealth-based RAP within a statewide referral center. Men referred for elevated PSA were evaluated using standardized triage and biopsy decision algorithms. Outcomes in the and pre- (October 2023-January 2024) and post-implementation (February 2024-October 2025) cohorts were compared. Primary outcomes included time from referral to initial consultation, MRI, and biopsy. Secondary outcomes assessed patient access, including travel distance, time, and cost savings. Detection rates of Gleason Grade Group ≥2 were assessed as a balancing measure.
There were 120 men in the pre-implementation cohort and 700 men evaluated through RAP. Median time from referral to: 1) initial consultation decreased from 63 to 18 days, 2) MRI from 120 to 51 days, 3) biopsy from 161 to 71 days, representing a 55.9% reduction in overall diagnostic interval (all p<0.001). Detection rates of csPCa were similar pre- and post-implementation (34.0% vs 39.4%, respectively; p=0.06). Median round-trip travel distance and time avoided were 58 miles and 66 minutes, respectively, resulting in median cost savings of $48.86 per patient.
Implementation of a telehealth-based RAP significantly reduced diagnostic intervals for men referred with elevated PSA while maintaining diagnostic quality. This scalable model demonstrates how telehealth-enabled workflow redesign can enhance timeliness and access.
Urology practice. 2026 Mar 31 [Epub ahead of print]
Zachary S Feuer, Heather Schultz, Fahad S Mohammed, Elizabeth Bullard, Elizabeth Weber, Angela Ford, Brendan Fitzpatrick, Matthew E Nielsen, Hung-Jui Tan
Department of Urology, University of North Carolina at Chapel Hill, North Carolina., UNC School of Medicine, Chapel Hill, North Carolina., Office of Quality Excellence, University of North Carolina at Chapel Hill, North Carolina., Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina.