Results released today from a National Audit of Cancer Diagnosis have shown that the average time it takes for a man to receive a diagnosis of prostate cancer in England is 56 days following referral – far longer than the average of 14 days for breast cancer and the 28 day target that health officials are working towards for 2020. We look into the reasons behind this dramatic difference and what is being done about it.
The data, published in the British Journal of General Practitioners, showed that diagnosis times for most cancers are falling behind the 28 day target, with prostate cancer one of the slowest to be diagnosed.
One reason for prostate cancer fairing badly in this study is likely to be that, until recently, men with raised PSA levels only had an MRI scan after undergoing a biopsy. Men often need some time to heal following the biopsy procedure before the prostate area is clear enough for an accurate MRI scan to take place.
This is starting to change though. As the results of the PROMIS trial showed earlier this year, diagnosis can be far more accurate if a man has a multi-parametric MRI (mpMRI) scanbefore he goes on to have a biopsy. Not only that, having the mpMRI scan first means the length of time to get a diagnosis can be much quicker, as there is no need to wait before having a biopsy if the scan shows that one is needed.
Two big reasons will be the fact that there is a UK population-wide screening programme for breast cancer and a large radiologist workforce dedicated to breast imaging. There has been a lot of attention on shortfalls in the radiologist workforce lately and this, along with screening, are two things we are working hard on. It’s well known that the tools we currently have to diagnose prostate cancer are not currently reliable enough to be used as population-wide screening programme, however through our research, are working towards developing the right ones.
We want all men in the UK with a raised PSA to have access to an mpMRI scan before they have a biopsy. If this technique is implemented well, then the length of time it takes to give a man his diagnosis should dramatically reduce.
There is already a lot of progress being made in this area. Last month, NHS England announced that they are funding a pilot project at three NHS Trusts to test a new model of care that uses mpMRI scans to reduce average prostate cancer diagnosis time to just eight days and referral-to-treatment time to 20 days. Funded by the National Cancer Transformation Programme the new process sees patients receiving an mpMRI scan and report, a clinical review and, if necessary, a targeted biopsy all on the same day. However, there is still much to do before men are routinely offered pre-biopsy mpMRI across the UK, and we are doing everything we can to make sure this happens.
Heather Blake, Director of Support and Influencing at Prostate Cancer UK said: “It is clear that it often takes far too long to get a diagnosis for cancer in the UK. Part of the issue for prostate cancer is that until recently men with raised PSA levels only had an MRI scan after undergoing a biopsy - a procedure which often needs time to heal before an accurate MRI scan can take place.
“The PROMIS trial showed earlier this year that prostate cancer diagnosis can be far more accurate if a man has a multi-parametric MRI (mpMRI) scan before the biopsy, which in turn can also help reduce waiting times due to cutting out the time lag in-between. This is the biggest leap forward in prostate cancer diagnosis for decades and we know that many areas of the UK are investigating ways to make pre-biopsy mpMRI a routine part of diagnosis for prostate cancer. We want every part of the UK to prioritise making the necessary changes so that men can benefit from the improved accuracy and speed of diagnosis as soon as possible, wherever they live.”