Nurturing mpMRI to lead to a breakthrough in diagnosis
“This is the biggest leap forward in prostate cancer diagnosis in decades with the potential to save many lives,” declared Angela Culhane, the chief executive of Prostate Cancer UK.
It’s not often that we get to say something like that, but it seemed appropriate on the day researchers announced that a more accurate form of MRI – known as mpMRI – could improve detection of aggressive cancers while reducing the number of unnecessary biopsies for men.
This is a significant step towards our ambition for a prostate cancer screening programme. Overcoming the harm done by unnecessary biopsies is one of the biggest hurdles to achieving this. If all men were screened for prostate cancer, then the harm from all those biopsies could outweigh the lives saved by early detection of cancer.
mpMRI will help to shift that balance and put us closer than ever before to having a nationwide screening programme. Prostate Cancer UK played a key role in making this game-changing research possible and we could only do that thanks to the generous donations from our supporters over many years.
PROMIS from early research funding
These results came from a trial, known as PROMIS, which made a hugely ambitious effort to show the benefit of mpMRI. But this may not have happened, if it weren’t for our efforts to bring together researchers from different areas.
The idea for PROMIS came from a forum held by the Prostate Cancer Research Foundation around 2008. I had a conversation with Chris Parker and we fleshed out the design for PROMIS. That’s where PROMIS was born. If we hadn’t had that meeting, PROMIS may not have happened.
In 2009, we awarded three grants totalling £136,000 to Professor Emberton and Hash Ahmed at University College London Hospital to test the feasibility of using mpMRI to detect prostate cancer.
Those studies provided data and evidence that allowed them to secure over £2 million in government funding to carry out the PROMIS trial.
“It’s difficult to get research funding when you want to try something radically different. Large research funders are very conservative in their decisions. Charity funding allowed us to test out a new idea; there was nowhere else to go. So when we applied for funding for the full trial it helped to have done these smaller studies as we already had very promising results,” says Professor Emberton.
One of the difficult issues for the trial was the need for template mapping biopsies. These are much more thorough than a standard TRUS biopsy, allowing the researchers to rule of small cancers that might have been missed otherwise. However this means they are much more invasive and men in the trial need to be given a general anaesthetic.
“The altruism exhibited by men was humbling and extraordinary. Most men were very uncomfortable with the existing diagnostic strategy and were aware of the imprecision in diagnosis but most men were willing to undergo a degree of risk to help us get there,” he says.
Driving change from research
mpMRI is now being rolled out nationwide and Prostate Cancer UK have been working with policymakers to ensure that every man has access to a high-quality scan. For men like Chris Kitcher, these scans can provide peace of mind:
“It was explained to me that having an mpMRI scan before a biopsy could help give an indication as to whether or not there was cancer in my prostate that needed investigation through biopsy. I’d heard from a friend that a prostate biopsy could be extremely painful and uncomfortable so was pleased to know that I wouldn’t be sent for one unless the doctors were confident I needed it.
“When the results of my MRI scan came back I was told that it had shown two spots on my prostate that would in fact need further investigation. I certainly wasn’t looking forward to it, but I decided that I would go ahead with the biopsy, as I needed to find out what was going on down there. The urologist told me that as a result of the MRI scan they would be able to use fewer needles in a targeted way because they knew where they needed to take samples from, so that helped.”
A lasting impact on prostate cancer research
Looking ahead to the future, the PROMIS trial will continue to help research. As the group of men taking part have been so thoroughly examined, their samples provide a unique resource.
“PROMIS will never be repeated because of the template mapping. So what you’ve got in PROMIS is the best characterised cohort that will ever exist,” says Prof Emberton.
“PROMIS also provides us with the only true negatives in prostate cancer research. For other studies, you can’t tell if the man is truly free of cancer, or if the biopsy just missed it. You can imagine trying to develop a biomarker against a reference test that is wrong half the time – you can’t.”
Prostate Cancer UK has provided further funding to collect samples, such as blood and urine, from these men, which can now be used by researchers to help develop better tests than relying on PSA alone.
Playing the long-game for big impact for men
It’s clear that research investment can take some time to pay off. But when it does, it can make a huge difference. We often have to play the long game with research, looking for those bright flashes of inspiration that need a bit of support to get them off the ground.
Those paths to impact might, in some cases, take years to achieve. But as the PROMIS trial shows us, the long game can and will pay off. In the coming years, we expect the research we're funding today to transform the diagnosis, treatment and prevention of prostate cancer in exactly the same way.
There is a long way still to go, but our goal is to stop prostate cancer from being a killer. The advances we have already made shows us that we are going in the right direction and, with your help, Prostate Cancer UK will be the key player in getting us the rest of the way there.