Registrar in the Department of Urology at UKZN’s College of Health Sciences, Dr Kiran Singh, won the Wismed Award at the 30th biennial South African Urological Association Congress (SAUAC) in Cape Town for his research titled: “Waiting Times for Prostate Cancer Diagnosis in KwaZulu-Natal”.
‘I am very excited, and grateful for the accolade. This further makes me optimistic about pursuing further research endeavours,’ said Singh, who is currently completing his second year of registrar training at UKZN after having completed his undergraduate MBChB in Cape Town in 2008.
Singh’s study, which found that KwaZulu-Natal patients were waiting three months (100 days) from referral to diagnosis, aimed to quantify waiting times and the efficiency of a prostate biopsy service.
According to Singh there is nothing in the literature, and specifically in the South African state sector, to suggest a time-frame interval patients should wait to receive a prostate biopsy after being referred to a specialist urology service with the clinical suspicion of prostate cancer.
‘Even though we as healthcare professionals know that prostate cancer is a slowly progressive disease, the word “cancer” naturally strikes fear and conjures up images of a fast-moving, life-threatening disease, with the impending accompanying psychosocial stressors.
‘Now more so, with the imminent wide-scale rollout of National Health Insurance in South Africa, we need to be able to quantify the burden and scope of prostate cancer on our health facilities, so as to ultimately improve the overall efficiency of the service we provide, thereby helping to alleviate patient anxiety during the stressful period of investigation.
Singh’s study was part of a larger MMed study conducted at St Aidan’s Regional Hospital during a six-month period from January to June 2013. A retrospective chart review of all prostate biopsies performed during this time period was collated and examined.
The study was conducted at St Aidan’s because this is where the vast majority of biopsies in the Durban KZN complex- state healthcare sector are performed.
The patients underwent transrectal ultrasound guided biopsies and only those with confirmed histological outcomes were included in the study cohort.
Singh said the methodology of the study was three-tiered – including defining the scope of the burden of disease, describing the referral patterns but, the focus of the presentation was based on the calculation of the waiting times observed.
More than 100 patients underwent guided needle biopsies during the study period. African patients accounted for almost 70% of patients biopsied, in contrast to the majority of epidemiological studies conducted in the Western Cape that have a Caucasian predominance, not representative of the demographics of South Africa.
Categorisation of the histology revealed almost half of all patients biopsied had confirmed adenocarcinoma. Of the patients with confirmed adenocarcinoma on histology, 80% received a bone scan, and almost three quarters of those were found to have skeletal metastases.
‘Our patients in KZN are presenting with more advanced disease as oppose to other centres in the country, limiting the treatment/ management options we are able to offer our patient. The average period of time from referral to biopsy was 55 days.
‘The median period from referral to first follow-up date (when the diagnosis was given and treatment options discussed or instituted) was an astounding 100 days. And from biopsy date to first follow-up date (waiting period to retrieve histological diagnosis) was 36 days,’ explained Singh.
He said due to the lack of understanding of the disease profile in KwaZulu-Natal, and lack of an updated National cancer registry, it was very difficult to draw guidelines, allocate resources and streamline biopsy services appropriately leading to an inefficient service, potentially missing curable disease and over treating some patient groups where prostate biopsy will not change their management plan.
‘Patients present with a more advanced disease in KZN as oppose to other provinces, with almost half (49%) having confirmed cancer at first presentation, with a significant proportion of those having metastatic disease at presentation if adequately staged when investigations are available.’
He plans to pursue a PhD related to prostate cancer and also do a Masters in Business Administration at some point, ‘I think, due to the current state of health care in SA, medical doctors need to start employing a business framework and mindset when trying to solve some of the challenges we face.’