About multiparametric MRI

We’re working to make sure that the training, equipment and expertise are in place to offer men an accurate and reliable multiparametric MRI scan before a biopsy by healthcare systems UK-wide.

Why do we need a new diagnostic?

For over 30 years, the only way to diagnose prostate cancer, and determine whether or not it needs treating, has been based on the results of a 'blind’ biopsy. This is a series of needles that randomly sample tissue across the prostate, to see whether or not it contains any cancerous cells.

The problem is that because there are gaps between the needles, sometimes even significant cancers can be missed if that section of tissue just isn’t sampled. The other problem is that biopsies are invasive and painful, and can sometimes lead to serious infections.

So finding a way to improve the number of aggressive prostate cancers that get caught in time, while reducing the number of men who have biopsies unnecessarily, is really important.

What we think

We think that an advanced type of imaging, called multi-parametric magnetic resonance imaging could be a massive step in the right direction.

A big clinical trial called PROMIS has just reported its first results, and suggests that having an mpMRI scan before a biopsy can make it possible to rule out the need for a biopsy in  a large number of men who don’t have a clinically significant prostate cancer. Although the first results have been announced at a conference, they still need to be confirmed by publication in a peer reviewed journal.

So will we be campaigning for UK-wide access whenf the PROMIS results are published, and these early results confirmed?

Well, not exactly, because as with most things, the situation is a little more complicated than it seems at first.

Firstly it takes a good deal of skill and expertise to effectively conduct and interpret mpMRI scans for everyone involved, from the radiographer conducting the scan, to the radiologist interpreting it, over to the urologist deciding what to do on the basis of that result.

Learning to do all this properly needs an effective training programme and quality control measures to be in place. Accurate interpretation and confidence amongst radiologists is crucial if we are to be sure that this technology will benefit men.

Secondly, not all MRI scanners are capable of carrying out mpMRI scans of the prostate that are accurate enough to enable clinicians to confidently rule out the need for further investigation.

Both these issues mean that pushing for an immediate roll out of mpMRI across the UK could in fact have some unintended negative consequences. For example, men could be incorrectly told that they do not need to go for further tests when they do in fact have a prostate cancer that needs treating. Or, possibly more likely, a large amount of time and funds might be spent on giving men mpMRI scans, but then they still all need to have biopsies, because the scans aren’t of a high enough quality, or interpreted confidently enough, to be able to rule this out.

Our plan

This technology is clearly a huge step forward, and could benefit men immensely. We can’t just leave things as they are. We want to get to a situation where men can access mpMRI wherever they are in the UK, and have the confidence that it is being done effectively.  

That’s why we already started working on this, before the clinical trial results were even reported, so that when the PROMIS trial results are published and confirmed, we will be in a position to advise health services what needs to happen to make sure all men with, or at risk of, prostate cancer can benefit from mpMRI before biopsy.

We'll be testing our approach in England, as we think the Cancer Strategy for England has some in-roads that could help us lever men's access to mpMRI, and once we've understood what was successful, we'll begin working in the devolved nations to make sure men across the UK can benefit from a more effective diagnostic. We're already planning to discuss this at a meeting in Scotland in early July.

The details

We’ve got the experts on board and are working closely with a group of radiologists who have an advanced understanding of the uses of mpMRI. We've surveyed all radiologists across the country and are following this up with a Freedom of Information request to find out what level of expertise there already is in this area, what type of MRI scanners are available, what training provision radiologists already have access to, and what other training they feel they need.

This will give us an idea of how the workforce looks now, and what needs to happen to get it where it needs to be if mpMRI is to be used more widely and effectively. We’ll also know where the right scanners are, but more importantly, we’ll know where they’re needed so we can start lobbying for them.

We’re also working on developing training and education courses with reputable expert organisations in the field, which we hope will ensure that patients receive a high quality diagnosis.

We're also exploring how we get quality control systems in place that make sure that newly trained radiologists, and the urologists they work with, are getting their scan interpretations right.

And of course, we’ll be interacting with NHS England and their counterparts in the devolved nations every step of the way to ensure they are aware of this potential step change in diagnosing a man with prostate cancer, and have it factored in to their plans.

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