cj test

The PSA blood test is the first step in the prostate cancer diagnostic pathway. It is a cheap, safe and effective way of identifying men who would benefit from further testing – in the first instance an MRI scan.

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• A multiparametric MRI (mpMRI) is now the recommended first-line investigation for men referred with a raised PSA blood test (≥3.0ng/mL).
• mpMRI is the recognised standard approach with NHS England’s Faster Diagnostic Pathway for prostate cancerⁱⁱ.
• The use of mpMRI before biopsy has increased, although it has not been fully implemented across the country. In 2018, we submitted a Freedom of Information Request to estimate mpMRI availability and patient eligibility rates. Availability was >95% and the most frequent eligibility rate stated by mpMRI adopters is estimated to be 90%.
• An mpMRI scan following referral, can rule out up to 27% of men from having a biopsy and can lead to fewer clinically insignificant cancers detected and treatedⁱⁱⁱ.
• MRI-targeted prostate biopsy can also reduce the diagnosis of clinically insignificant prostate cancer^iv.
• Prostate biopsies can have harmful side effects, which in rare cases can include sepsis. Transperineal biopsies are now an option supported by NICE^v,vi which carry a lower risk of sepsis. A recent cohort study found that between 2017-2019, 33% of prostate biopsies were transperineal biopsies, and 67% were transrectal biopsies. The sepsis rates were 0.42% for transperineal and 1.12% for transrectal^vii.
• National Prostate Cancer Audit data shows that in 2019 40% of men diagnosed had a Transperineal biopsy, rising to 64% 2020^viii.
• Men with localised, low- and low-intermediate risk prostate cancer, eligible for active surveillance, can delay or avoid radical treatment for 10-15 years avoiding associated side-effects^ix,x.
• Active surveillance for men with localised, clinically insignificant prostate cancer supports the reduction of over-treatment, with similar 10-year mortality outcomes compared to men being radically treated^xi. The National Prostate Cancer Audit (NPCA) have reported annual reductions in the rates of ‘over-treatment’ of low-risk disease (from 12% in 2016 to 4% in 2022)^xii.