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A Big Step Forward In Diagnosing Prostate Cancer

20/01/2017 08:09
Jirsak via Getty Images

If prostate cancer is famous for one thing - other than the digital rectal examination of course - it is the unreliability of the route to diagnosis. This has serious implications for men. Harmful prostate cancer can be missed in 1 in 4 men by the current standard way of carrying out biopsy, because the transrectal ultrasound (TRUS) guided biopsy takes random samples from across the prostate.

This and the unreliability of the PSA test means there is no UK population-wide screening programme. Just as it can miss harmful cancers, TRUS guided biopsy can detect a cancer that would never do a man any harm. These men, if treated radically - such as surgery or radiotherapy - can then live with often life-changing side-effects that they may have never needed to experience.

But without a population-wide screening programme, we will struggle to always detect harmful forms of the disease early before the cancer spreads, by which time the reduced choice of treatment options means it is often too late to successfully treat the cancer.

Today we have taken a big step towards solving this dilemma. The final full results of a ground breaking research study - PROMIS - have been published in the Lancet. The findings show that giving a man a multi-parametric MRI (mpMRI) scan before a biopsy can radically improve the accuracy of the diagnostic process for prostate cancer. The results from the trial make it clear that giving an mpMRI scan to men with a raised PSA before they have a biopsy can help increase the number of clinically significant cancers detected. The technique also helps make sure that for those men who go on to have a biopsy, the needles are more directly targeted to the suspicious areas. And some men may be able to avoid even having biopsy and, in some cases, unnecessary treatment, if nothing suspicious shows up on the mpMRI scan. This is truly ground-breaking and will reduce the risk of overtreatment that is one of the factors currently preventing a population-wide screening programme.

The challenge that we have been grappling with at Prostate Cancer UK is working out what now needs to change in healthcare practice across the UK to make prostate mpMRI before biopsy a routine part of diagnosis. It is a complex technique that requires specific skills and equipment for it to deliver the best outcomes for men. If clinicians are not adequately trained to conduct and interpret the scans, they may lack the confidence to rule the right men out of biopsy, limiting the benefits of having earlier mpMRI scans. On the other side of that, some men could be incorrectly told they do not need further tests when they in fact do. In addition, there needs to be enough scanners and they need to be calibrated in the right way.

Prostate Cancer UK has a plan, and we have been working with some of the best urologists, radiologists and radiographers in the UK, as well as their professional bodies, to develop it and make it happen. It includes developing a bespoke training programme for radiologists with the Royal College of Radiologists. We've also worked with clinical experts to develop a checklist for those who commission and fund cancer services. It sets out what they need to put in place to make sure of cost-effectiveness and the best outcomes for men. And we are working in partnership with University College London Hospital (who ran the PROMIS trial) to develop a clinical consensus that will set standards and guidelines for best practice and consistency for this complex technique.

We have also carried out research across the UK to find out where mpMRI before biopsy is being used already, and found that one third of men with suspected prostate cancer are currently being diagnosed using the PROMIS trial's method. So we are speaking to national health bodies to establish where resources can be targeted to increase the numbers of men accessing this new technique, in a way that makes the most of stretched NHS funding.

Cancer strategies and plans across most of the UK emphasise early diagnosis as a priority, and this breakthrough gives us the opportunity to make a big difference to the most common cancer experienced by men. Ultimately if we can ensure that every man with a suspicion of prostate cancer is diagnosed in this way, we will not only improve their outcomes directly, but we will have taken a big step on the way to being able to introduce a screening programme. This is the game-changer for prostate cancer which would put us on the road to taming this disease for good.

www.prostatecanceruk.org

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