Evidence continues to mount for giving men an mpMRI scan before a prostate biopsy after an international trial of 500 men showed that mpMRI-guided biopsies help to catch more aggressive cancers and fewer harmless cancers.
As we’ve reported before, mpMRI is the new big thing in prostate cancer diagnosis. The PROMIS trial showed in 2017 that these advanced scans could help to reduce the number of men having unnecessary biopsies - a key hurdle to overcome in the drive towards having a screening programme.
Now, new research has confirmed that mpMRI scans can also be used to target biopsies to more accurately catch aggressive cancers. The trial, carried out with 500 men across 11 countries, found that 38 per cent of men were diagnosed with a clinically significant (Gleason score of 7 or higher) cancer with mpMRI-guided biopsies compared to only 22 per cent having a standard trans-rectal ultrasound (TRUS) biopsy. This suggests that a large number of aggressive cancers are being missed because of blind biopsies.
Karen Stalbow, Head of Policy, Knowledge and Impact at Prostate Cancer UK said: “We’ve known for some time that 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. This is simply not good enough.
“However, today’s results provide further high quality evidence confirming that prostate biopsies, when targeted using MRI, are more accurate at detecting harmful cancers than a TRUS biopsy alone. It is now more important than ever that all men with suspected prostate cancer get a mpMRI scan before biopsy. This will not only reduce the number of unnecessary biopsies for men with no or low grade cancer, but will also ensure that those men with more harmful types of the disease will benefit from a much more targeted approach, reducing the chances that their cancer is missed.
“Prostate Cancer UK will continue to make sure the NHS prioritises the adoption of mpMRI before biopsy, so that it is available to all men with suspected prostate cancer, no matter where in the UK they live.”
Having an mpMRI-targeted biopsy also helped to reduce the side effects experienced by men and reduce the number of harmless cancers detected.
Dr Veeru Kasivisvanathan of University College London and first author of the study, said: “There are some important health service changes that would need to be made to allow an MRI pathway to be more commonly used. Clinicians would need to be trained to perform the MRIs to high standards and to report the MRIs to high standards. In addition MRI capacity would need to be increased to accommodate more men being scanned."
Here at Prostate Cancer UK, we believe mpMRI before biopsy offers the potential for a step-change in prostate cancer diagnosis. Our early research funding helped to show that this approach was feasible and led to the PROMIS trial.
We have been working since January 2016 to make sure that, by 2020, every man with suspected prostate cancer can get access to mpMRI scan before a biopsy. Next month we will be updating our Freedom of Information Request to find out how the availability of this technology has changed across the country and therefore how many men can have these scans. To support our work, please sign up to March for Men this summer.