About the project

The published results of the Prostate MRI Imaging Study (PROMIS) in the Lancet have shown that giving a man a multi-parametric Magnetic Resonance Imaging (mpMRI) scan before a biopsy can radically improve the accuracy of the diagnostic process for prostate cancer.

Here at Prostate Cancer UK, we believe mpMRI before biopsy offers the potential for a step-change in prostate cancer diagnosis. Results of the PROMIS trial have shown mpMRI before biopsy to be significantly better at identifying clinically significant prostate cancer compared to TRUS (trans-rectal ultrasound) biopsy, and can also reduce the number of men having biopsies unnecessarily by a quarter (27%) because the scan will only pick up cancers which could cause men harm and need further tests.

To coincide with the publication of the PROMIS trial, we are releasing Freedom of Information request data which highlights the challenges that must addressed as a priority if this game-changing diagnostic technique is to reach all eligible men in the near future. The specific challenges 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.

We’ll be working to ensure that prostate mpMRI before biopsy becomes a priority for early diagnosis ambitions in each of the UK’s nations and want to work collaboratively with each national health service to establish ways to overcome the scanner capacity and resource challenges that we have identified.

Why we’re doing it

This represents a real step forward in improving the accuracy of prostate cancer diagnosis, which is why we want all men with suspected prostate cancer who could benefit to have access to an mpMRI scan before a biopsy wherever they are in the UK. We also want these men to have the confidence to know that it is being done effectively. We know that mpMRI before biopsy is a complicated procedure and to deliver this effectively there needs to be the right equipment, training and support for healthcare professionals. When delivered effectively men could benefit from:

  • Fewer unnecessary biopsies
  • Improved ability to detect clinically significant cancer
  • More targeted biopsies where they are needed

Our Freedom of Information request research has revealed that just a third (32%) of eligible men with suspected prostate cancer will benefit from having an mpMRI scan before biopsy unless action is now taken to change the status quo and ensure this technique becomes routine. Our aim is to remove barriers and support hospitals across the country to deliver mpMRI before biopsy as swiftly and effectively as possible.

Making it happen

Addressing capacity issues

There are a number of specific challenges that are preventing all men having access to this diagnostic treatment, including: not having enough of the right scanners and the need to potentially increase the capacity of the radiologist and radiographer workforce.

Our Freedom of Information request data will show national commissioners like NHS England where there are hospitals that want to adopt prostate MRI before biopsy, but that are limited in doing so by insufficient scanner capacity. We will be pressing for the use of funding that these national commissioners have already made available for delivery of early diagnosis ambitions (National Diagnostics Capacity Fund in England and Diagnostics Fund in Scotland), to support these hospitals to upscale their scanner capacity.

We are also aiming to partner with relevant professional bodies, like the Royal College of Radiologists to tackle workforce capacity.

Supporting clinicians

We want to ensure that healthcare professionals are supported and have the right skills and expertise to conduct and interpret mpMRI scans effectively, 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.

Prostate MRI before biopsy is a complex technique,requiring specific scanner calibration, use of a dynamic contrast enhancement agent as well as specific positioning of the prostate for the scan and all in 25 minutes. Confidence is also needed to interpret the scans and have the assurance to rule some men out of a biopsy.

To support clinicians, we are working with the Royal College of Radiologists to develop webinar and face to face training programmes. We are also working with the Society and College of Radiographers to develop clear protocols for scanner calibration, whatever make of scanner is used.

Equally important is consistency of practice and making sure of quality, so we are working with a breadth of clinical expertise to develop a clinical consensus that sets standards for prostate MRI before biopsy, while also providing radiologists with a cloud-based quality assurance programme that will let them test their skills and engage with radiologists already expert in using mpMRI before biopsy. 

Working with commissioners

We’re supporting the commissioning of this technology in England and have been working with a group of clinicians to develop a ‘checklist’ which can be downloaded that sets out what we believe should be in place for Clinical Commissioning Groups to commission mpMRI before biopsy effectively.

The checklist can also be adapted for use in other nations, supporting national commissioners or health board procurement teams to put in place what is needed to make sure this diagnostic imaging technique delivers the best outcomes for men

How you can help

  • Sign up to receive our CCG commissioning checklist to see which criteria our expert clinical group think should be in place in order to deliver the best outcomes for men. To make sure you're the first to hear about this add your name to our mailing list.
  • Radiologists – watch this space for bespoke training on mpMRI delivered in conjunction with the Royal College of Radiologists
  • Sign up to our free online learning portal and watch our webinar on mpMRI. You can also watch the presentation we gave at the BAUS conference in 2016 - mpMRI: solving the challenge of delivery.

To get involved directly with our work, please contact Jonny Savage, Senior Policy Officer – jonny.savage@prostatecanceruk.org

Read all news