Access to mpMRI before biopsy increasing but parts of UK are still 'appalling'

A Freedom of Information (FOI) request from Prostate Cancer UK has found that large parts of the UK still don’t have access to the latest diagnostic scans for prostate cancer, eighteen months after the PROMIS trial first proved multiparametric MRI (mpMRI) before a biopsy could radically boost detection of prostate cancer and cut unnecessary biopsies.

While there has been a 63% increase in access overall since last year, the NHS data revealed many hospitals in Wales and Northern Ireland don’t offer the scans at all, and their availability and quality in England and Scotland varies hugely.

The greatest improvements have been across England and parts of Scotland, where roll out of mpMRI has been prioritised by health commissioners and supported by us.

But only 57% of areas across the UK are providing scans before biopsy to the highest evidence-based standards, while 13% offer no access to mpMRI – including North and West Wales, Northern Ireland, parts of North West England and parts of Scotland.

That's why we're calling on NHS decision-makers in areas offering no access to prioritise whatever changes are needed to make pre-biopsy mpMRI available without delay. And why we're also lobbying the NHS nationally to address variation in the level and quality of scans being given across the UK.

"This groundbreaking diagnostic tool is the biggest leap forward in prostate cancer diagnosis for decades and it is therefore appalling that health officials in some areas are still not seeing this as a priority," says Heather Blake, our director of support and influencing.

"We urge Health Departments and commissioners in the worst offending areas to step up and focus their efforts on getting mpMRI before biopsy to men without delay."

Our FOI request also found almost a third of areas are providing mpMRI before biopsy, but not to a sufficiently high standard.

Many are cutting out the use of a dye, called Dynamic Contrast Agent (DCE), which was proven in the PROMIS trial to increase the scan's accuracy but adds time to the scanning process. While 41% of those who do scan to the PROMIS standard are either restricting access to men who fit a particular age or PSA level, or just not offering it to all men who could benefit.

"As overstretched radiology units do their best to deliver mpMRI before biopsy to as many men as possible, we're seeing quality and equality of access compromised in some areas," says Heather.

"NHS decision-makers in all parts of the UK must identify and address the barriers preventing all eligible men from accessing a high quality mpMRI scan before a biopsy. Every man with suspected prostate cancer deserves the chance of a more accurate diagnosis."

Ever since the initial findings of the PROMIS trial were first released in 2016, we've been busily working with the relevant professional bodies and experts to develop training and guidelines that will help commissioners and health professionals rollout and deliver mpMRI to a consistent high standard.

As a result, a consensus statement from clinical experts that outlines best practice for mpMRI was published today in the British Journal of Urology International. It includes protocols for radiographers to get the best results from the more complicated scanners, which were developed with the Society and College of Radiographers.

"I think we've outlined broadly where the areas of need are if we want to make this technique successful, but it will need a lot of support from the various professional bodies, the NHS and government to fully implement across the UK," says Dr Shonit Punwani, UCLH BRC Director of Clinical Imaging (pictured below), who spent 18 months leading on the consensus with more than 20 clinical experts.

As well as funding from us and London Cancer, he credits Prostate Cancer UK with being "the driving force" in making the clinical consensus happen and is in no doubt how revolutionary its rollout will be for diagnosing men.

"When I first started reporting prostate scans, I'd see patients who'd had repeated biopsies without finding the tumour before having a standard scan," says Dr Punwani.

"Now they have an mpMRI first, identify the tumour, have one biopsy and get a result. The benefit is unequivocal."