To Örebro University

Introduction & Objectives: The diagnostic workup for suspected prostate cancer is often emotionally distressing and may negatively affect patients’ well-being. Considerable variability exists in waiting times across diagnostic pathways, yet evidence on how such delays influence psychological distress is limited. Objective: To assess whether a fast-track diagnostic workup reduces psychological and physiological stress among men with suspected prostate cancer.

Materials & Methods: In this randomized clinical trial, 304 men referred for suspected prostate cancer at the Urology Department, Örebro University Hospital (Sweden), were randomized to either a fast-track diagnostic workup—aiming for the shortest possible waiting time—or usual care. Primary outcomes were patient-reported symptoms of distress (anxiety, depression, perceived stress, and sleep disruption); secondary outcomes included physiological stress markers, such as diurnal salivary cortisol. Data were collected from randomization to 12 months post-enrollment.

Results: Men in the fast-track group had a significantly shorter waiting time to their first consultation (median 7 days) compared with the usual care group (median 35 days). During the first six months, participants in the fast-track arm reported lower levels of distress, anxiety, and perceived stress, and improved sleep quality. Among those undergoing prostate biopsy, the strongest intervention effect was seen one to four weeks post-procedure. For men subsequently diagnosed with prostate cancer, the effect was most pronounced one week after biopsy. Differences between groups were no longer evident at 12 months. Diurnal cortisol profiles indicated a more favorable stress pattern in th efast-track group, especially during the period surrounding diagnostic disclosure.

Conclusions: A fast-track diagnostic workup for suspected prostate cancer substantially reduces psychological and physiological stress during the diagnostic phase. These findings support the implementation of accelerated diagnostic pathways in urological practice to improve patient experience and potentially reduce stress-related health risks.