Optimising the prostate cancer diagnostic pathway in a tertiary hospital in Karachi: a two-cycle quality improvement project

Delays in the prostate cancer diagnostic pathway can prolong patient anxiety and delay treatment planning, particularly in high-volume resource-constrained settings. At Lifeline Hospital, Karachi, a care centre receiving approximately 60–70 suspected prostate cancer referrals per month, a baseline audit of the urology pathway (Cycle 1, November–December 2024) identified delays. Median referral-to-clinic, clinic-to-biopsy and biopsy-to-multidisciplinary team (MDT) intervals were 25.3, 28.0 and 18.3 days, respectively, and only 47% of patients completed diagnosis and treatment planning within the project’s primary 8-week benchmark from referral. This benchmark was informed by internationally recognised standards, including National Institute for Health and Care Excellence NG12 referral criteria and the National Health Service England Faster Diagnosis Standard and adapted to reflect local service constraints. This quality improvement project was registered locally as a service evaluation.

Following multidisciplinary stakeholder engagement and process mapping, three pragmatic interventions were introduced in early January 2025: (1) an additional weekly one-stop urology clinic, (2) expanded local anaesthetic transperineal biopsy capacity and (3) administrative prioritisation of urgent referrals, imaging coordination and MDT preparation. A reaudit of consecutive patients in Cycle 2 (January–February 2025) evaluated pathway performance after implementation.

Median clinic-to-biopsy time fell to 16.8 days (reduction 11.2 days; 40%), and biopsy-to-MDT time decreased to 7.6 days (reduction 10.7 days; >50%). Referral-to-clinic time improved modestly to 22.3 days. The proportion of patients completing diagnosis and treatment planning within 8 weeks increased from 47% to 58%.

This two-cycle quality improvement project shows that low-cost operational interventions targeting clinic capacity, biopsy access and administrative coordination can improve timeliness in prostate cancer diagnosis and treatment planning in a tertiary hospital setting. Further gains are likely to require better prediagnostic imaging pathways, faster reporting and sustained postproject monitoring. These findings offer a practical framework for tertiary hospitals in Pakistan aiming to optimise cancer diagnostic pathways within existing resource constraints.