A piece in yesterday’s Times by Chris Smyth, Health Editor:
Men thought to have prostate cancer must be given MRI scans on the NHS, campaigners said yesterday after a study confirmed that it was the most accurate way to diagnose the disease.
Use of MRI could allow a quarter of men being tested to avoid painful biopsies and pick up more dangerous cancers than the “stab-in-the-dark” methods used at present, the trial concluded.
NHS bosses have been urged to make such scans the routine testing method after the latest evidence that they could save lives and spare men side-effects.
Although many cancers are diagnosed using scans, men who have symptoms of prostate cancer must have a transrectal ultrasound-guided biopsy (Trus), in which a needle is inserted through the rectum to take a sample.
A British study last year compared biopsies to scans in the same men and found that the multiparametric MRI identified twice as many aggressive tumours and could have ruled out cancer in a quarter of patients.
An international study of 500 men has now found that MRI checks spared 28 per cent of men a biopsy. For those with worrying scans, using the MRI image to target the biopsy found significant cancers in 38 per cent of men, compared with only 26 per cent in those given standard, untargeted biopsies, according to results published in The New England Journal of Medicine.
Veeru Kasivisvanathan of University College London, who presented the research at the European Association of Urology congress in Copenhagen, said that the results showed that “using an MRI to identify suspected cancer in the prostate, and performing a prostate biopsy targeted to the MRI information, leads to more cancers being diagnosed than the standard way that we have been performing prostate biopsy for the last 25 years”. He added: “A diagnostic pathway with initial MRI assessment, followed by biopsy when required, can not only reduce the overall number of biopsies performed but can give more accurate results.”
Karen Stalbow, of Prostate Cancer UK, said: “An MRI scan could and should be used to help guide prostate cancer biopsies. For too long men have had to endure a stab-in-the-dark biopsy technique, which can miss one in four harmful prostate cancers.”
She urged the NHS to prioritise the training and equipment needed to make MRI standard, saying that the latest findings gave “further high-quality evidence confirming that prostate biopsies, when targeted using MRI, are more accurate at detecting harmful cancers than a Trus biopsy alone”.
The National Institute for Health and Care Excellence is due to decide next year whether NHS diagnostic methods must change, weighing up the cost of more £400 scans against fewer £500 biopsies and better treatment. Dr Kasivisvanathan said that the study told doctors “how to use the MRI information in real-life practice, and showed us that when using MRI to target biopsies to abnormal areas on MRI, that it is superior to Trus biopsy. The evidence suggests that the MRI pathway may be cost effective in a number of different healthcare settings. This is because costs are saved from a proportion of men avoiding biopsy altogether, earlier diagnosis of harmful cancers and the avoidance of diagnosis of harmless cancers.”
Hein Van Poppel, of the urology association, said: “MRI use also shows up small aggressive cancers at a curable stage and allows us to delay or simply not perform biopsies for some cancers which will not turn out to be dangerous. We need time to digest the study, but at first reading it looks like it has the potential to change clinical practice.”
You can subscribe to The Times here.
