CADMUS: Using ultrasounds to spot cancer

• A new imaging technology called mpMRI has helped improve prostate cancer diagnosis and reduce the number of unnecessary biopsies men experience. However, the technology is expensive and not all men are suitable for it.
• Multiparametric ultrasound may be an alternative imaging technique to diagnose prostate cancer that is cheaper and suitable for more men than mpMRI.
• Professor Ahmed is running a clinical trial to compare multiparametric ultrasound against existing diagnostic techniques, to see if it could be used widely in the clinic.

Multiparametric MRI (mpMRI) is a newly developed type of imaging technology which can produce a much more detailed picture of the prostate than a standard MRI scan. Following a series of studies, including one funded by us, it was shown that mpMRI could be used to spot aggressive prostate cancers and guide biopsies to improve the diagnosis of prostate cancer. We’ve since campaigned for this technology to become widely available in the UK so more men can have access to improved technology for diagnosing prostate cancer.

However, multi-parametric ultrasound is another imaging technology which may have some benefits over mpMRI. A multi-parametric ultrasound scan is much faster than an mpMRI scan, which has cost benefits for the NHS. It also uses standard technology already available in most hospitals, unlike mpMRI which requires most hospitals to invest in new equipment. Finally, not all men are suitable for mpMRI, like those with pace makers or metal implants, or those who are claustrophobic, and so multi-parametric ultrasound could be a good alternative for them.

Professor Ahmed at Imperial College London wants to test whether multi-parametric ultrasound is as good at spotting aggressive prostate cancer as mpMRI, and so could be used instead of mpMRI in some cases.

Professor Ahmed and his team are recruiting men who have already had a biopsy for prostate cancer which showed a negative or low risk of the disease, because these men often undergo further biopsies during their lifetime.

Each man will have a template mapping biopsy, which takes up to 25 samples and is a very accurate way to spot prostate cancer. They will then have an mpMRI scan and a multiparametric ultrasound scan. If the multiparametric ultrasound scan produces the same result as the template mapping biopsy and the mpMRI scan, this will indicate it is just as effective as spotting prostate cancer, and so could be used as an alternative diagnostic technique.

Trial has begun recruiting and is open at all the planned sites, which you can find below.

This trial is still looking for men to take part. You can read the information below to see if you may be suitable to take part in this study, and contact your medical team for full details on whether you can take part.

If you’d like support with deciding whether taking part in a clinical trial is right for you, you can speak to your medical team or contact our Specialist Nurses on 0800 074 8383.

Who can take part

You may be eligible to take part in this study if you have:

• A potential need for a prostate biopsy, as indicated by raised PSA or other clinical parameter, the final decision over which will be taken after imaging.
• A PSA less than or equal to 20ng/ml measured within 6 months of screening visit
• An understanding of the English language sufficient to understand written and verbal information about the trial and consent process
• Estimated life expectancy of 5 years or more
• Signed informed consent

Who can’t take part

You would not be eligible to take part if you:

• Any contraindication to the ultrasound contrast agent including right to left shunt, pulmonary hypertension and uncontrolled hypertension. Also patients with an acute coronary syndrome within the last 6 months or ischaemic heart disease that’s not well controlled by medication.
• Any form of androgen deprivation or hormones (except 5-alpha reductase inhibitors) within 6 months of screening visit
• Irreversible coagulopathy predisposing to bleeding
• Inability to undergo transrectal ultrasonography
• Prostate volume, measured at the time of mp-USS if previously unknown, of >60cc.
• Previous radiation therapy to the prostate
• Previous HIFU, cryosurgery, thermal therapy, irreversible electroporation, photodynamic, photothermal therapy, microwave or injectable toxin therapy to the prostate.
• Transurethral resection or vaporization of the prostate for benign prostatic hyperplasia using any energy modality within 6 months of screening visit
• Nodal or metastatic prostate cancer on any form of imaging at any time-point
• Not fit for general anaesthetic
• Any other condition the investigator considers would make the patient unsuitable.

For full inclusion and exclusion criteria speak to your medical team.

Where the trial is taking place

• Southend University Hospital NHS Foundation Trust
• Barts Health NHS Trust, The Royal London Hospital
• Imperial College Healthcare NHS Trust
• Ashford & St Peter's Hospitals NHS Foundation Trust

Speak to your medical team for the most up to date information on prostate cancer studies you may be eligible for.
For a general discussion about clinical trials, you may like to talk to our Specialist Nurses.

Researcher - Professor Hashim Ahmed
Grant award - £171,677
Duration - 2015-2019
Reference - PG13-025