mpMRI before biopsy can radically improve diagnosis  

Results from the ground breaking research study – PROMIS (the Prostate MRI Imaging Study) – show that giving a man a multi-parametric MRI (mpMRI) scan before biopsy can radically improve the accuracy of prostate cancer diagnosis.

This is a game-changing technique and we’re working to make sure it is available in the near future to all men with suspected prostate cancer who could benefit from it.

What we know

Our research shows that without action to put the PROMIS findings into practice and change the current situation, just a third of eligible men (32%) with suspected prostate cancer across the UK will benefit from having an mpMRI scan before biopsy.

The specific challenges to achieving this, highlighted by our Freedom of Information request data, include having enough of the right scanners in the right places, training and increasing capacity of the radiologist and radiographer workforce, ensuring uniformity and quality of method and willingness to change.

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About mpMRI

A standard MRI scan creates an image of an internal organ. But unfortunately, it is rarely clear enough to confidently diagnose early prostate cancer. That’s where mpMRI, or multi-parametric magnetic resonance imaging, is different. By combining up to three different types of scan, we can get a clearer picture of what’s going on in the prostate. Also, an injection of a contrast agent means that scan images can be enhanced making it clearer to see if cancer is present or not.

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 random TRUS biopsy. This involves using 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 significant cancers can be missed if that section of tissue isn’t sampled. The other problem is that although biopsies are a key part of diagnosis, they are invasive and painful, and can sometimes lead to serious infections – so we only want men to have them if they need them. Finding a way to improve the number of aggressive prostate cancers that get caught in time, whilst reducing the number of men who have biopsies unnecessarily, is really important. Multi-parametric MRI can do both of these things as well as ensuring that the biopsies that do happen are able to be much more targeted to where the cancer actually is in the prostate.

The challenge we face calling for UK-wide access to mpMRI

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. Accurate interpretation and confidence in this technique amongst all the clinicians involved is crucial if we are to be sure that this technology will benefit men.

Also, MRI scanners are in high demand across the NHS, which means that some hospitals may struggle to have the capacity to conduct mpMRI scans before biopsies with the current number of scanners they have. And we know that there are simply not enough radiologists and radiographers in place to meet the mpMRI scan needs of all the men with suspected prostate cancer.

What we are doing

We are taking action to support and encourage health bodies at a national and local level across the UK to address their resource challenges. We have carried out Freedom of Information request research with Trusts, Health Boards and Health & Social Care Trusts across the UK to find out about which areas are already doing this technique, MRI scanner capacity and barriers preventing every eligible man accessing it. We will share this research with national commissioners like NHS England and work with them to make funding available for new resource and capacity in those hospitals that want to adopt or increase mpMRI before biopsy. That way, we can make sure we’re getting this new imaging diagnostic to men as soon as possible.

We’re also aiming to partner with relevant professional bodies to see how we can tackle workforce capacity too.

We’re also taking action to make sure local NHS providers can hit the ground running when it comes to making the required changes to practice and are working with experts from across the field to do this.

We’re developing a bespoke training programme for radiologists in collaboration with the Royal College of Radiologists, and creating a checklist for funders of cancer services, which sets out what they need in place to make sure their adoption of mpMRI before biopsy delivers the best outcomes for men.

We’re also working in partnership with University College London Hospital, where the PROMIS trial took place, to develop a clinical consensus that will invite experts to set standards and guidelines for best practice and consistency for this complex technique.

And we’re looking into providing radiologists with a quality assurance programme that will let them test their skills and engage with radiologists who are already experts in using mpMRI before biopsy. This will ensure that mpMRI biopsies are carried out to high quality standards and therefore leading to the best outcomes for men.

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