06 Jun 2016

How we're working to turn the PROMISing results of mpMRI trial into a reality for men

From training up radiologists to working alongside commissioners and the NHS, Dr Sophie Lutter explains how we're making sure the results of the PROMIS trial are rolled out into real-life hospitals as soon as they've been peer-reviewed, and why rushing it could do more harm than good.

The results of the PROMIS trial, as they were presented at the American Society of Clinical Oncology (ASCO) conference today, potentially represent a huge leap forward in improving prostate cancer diagnosis.

We can’t yet say anything specific about the number of men who could benefit – we’re waiting for the peer-reviewed publication for that. However, the results so far do seem to offer the potential for a significant proportion of men to safely avoid the pain, discomfort and risk of complications from a TRUS biopsy, if they had an mpMRI scan as soon as they’re referred to an urologist.

This is likely to also prevent some of these men going on to be unnecessarily treated for a cancer that would never have harmed them if left alone.

When exciting research findings like this come along, it’s so tempting to say, "This is brilliant! All men must have access to this breakthrough technology right away!" But as ever, things aren’t quite that simple, and calling for this technology to be made available everywhere right now would not lead to benefits for men. In fact, it could do more harm than good.

What’s in the way of immediate roll-out?

This technique has taken the research team who led the trial years to perfect, and radiologists need training to develop sufficient confidence in their interpretations of prostate MRI scans to rule men out of a biopsy.

In addition, commissioners need to know exactly what resources should be in place to make this pre-diagnostic as effective and reliable as possible. We already know that not everyone who’s already doing prostate mpMRI is doing it the same way, or to the same standard. Everyone needs a standard set of parameters to work to, so that wherever you are in the country, the type of scan you get is the same.

We – and the commissioners – also need to know what scanner capacity already exists in the UK. Not only how many scanners there are, but how much time they have available to increase the number of prostate scans they carry out, since in most places the same scanners will also be used for all the usual broken leg and dodgy hip scans too.

Finally, since we know that there won’t be the resources to buy new scanners everywhere, we need to know what men consider to be a reasonable distance to travel to get this non-invasive, pre-diagnostic test.

What are we doing about it?

We’ve already started working with the Royal College of Radiologists, radiologists themselves, radiographers, urologists, members of the PROMIS trial team and Clinical Cancer Leads at two prominent Clinical Commissioning Groups to address all of these issues.

Radiologist training
Radiologist training is clearly going to be absolutely crucial to make sure these exciting research results follow through on their promise of a massive leap forward for men. We’re working with the Royal College of Radiologists to pilot a training programme that will roll out later this year.  

Working with commissioners
We’re also taking a first-of-its-kind approach to assist the commissioning of this technology, working with a group of relevant people to develop a ‘checklist’ of resources that will be needed to get mpMRI before biopsy in place. This will be available as soon as possible after the PROMIS results are published.

Working with NHS England
We will also be inviting NHS England to work with us and their new National Diagnostics Capacity Fund to understand whether we already have enough scanners to make this diagnostic tool a reality for all men, or whether we need to campaign for more. We know that we need to be realistic about this, and access for every man will not mean prostate mpMRI scans available in every hospital. So we need to work with men to establish what they consider to be a reasonable distance to travel for this type of non-invasive pre-diagnostic test.

Setting a standard
Finally, we will work with radiologists and radiographers who have already become experts in prostate mpMRI before biopsy to develop a clinical consensus that will provide health professionals with the guidance they need to  achieve the technical standards and quality assurance levels needed to give men a positive diagnostic experience, reduce cancer referral waiting times and hopefully deliver cost benefits to the NHS.

Finally, one further bonus of the PROMIS trial is that in the process of carrying out the trial (funded by the NIHR and MRC), we funded the researchers to build a huge biobank of prostate cancer tissue samples. This resource is unmatched in terms of detail and quality by any other biobank in the world. This is because not only do they have samples from a TRUS biopsy, but these are matched to samples from a more comprehensive and accurate template biopsy, which means that the scientists know just how representative – or otherwise – the TRUS sample is of the whole, or most dangerous, cancer. It's an invaluable new resource for all future prostate cancer researchers.

We’d like to know your views on how far you’d be prepared to travel for an mpMRI scan. Please tell us by filling in our survey.