A type of specialist MRI scan has been recommended as one of the first tests for diagnosing people with suspected prostate cancer by the National Institute for Health and Care Excellence (NICE).
Right now, men with suspected prostate cancer are offered a blood test that looks for raised levels of a molecule called prostate specific antigen (PSA). Men with raised PSA levels will be offered a biopsy, which involves inserting a needle into the prostate to take samples.
NICE has recommended that the specialist imaging, called multiparametric (or mp) MRI, is offered before a biopsy.
The mpMRI scan combines 3 or 4 different images, which can help doctors build a clearer picture of what’s going on in the prostate.
Professor Mark Emberton, a prostate cancer specialist from University College London, said we’re the first country in the world to make this recommendation.
“It’s the first test that we’ve managed to develop that can help men avoid a biopsy, and it’s a decision based on research done in the UK, so there’s a lot to be excited about.”
Preventing unnecessary tests
Around 47,000 people in the UK are diagnosed with prostate cancer each year. According to figures from NICE, around half of those diagnosed with prostate cancer in England between April 2015 and April 2016 had an mpMRI.
The new guidance will help to ensure that more men are offered the test, which can reduce the need for unnecessary prostate biopsies.
The latest results from a study involving 500 men showed that 1 in 4 men with an abnormal PSA test or rectal exam didn’t need a biopsy, as the scan showed no abnormalities.
And for men who did need a biopsy, the scan results helped guide doctors taking these tissue samples. This made it less invasive and more likely to pick up abnormal cells than a standard biopsy.
NICE decided that mpMRI would be cost effective for the NHS, as it will help to reduce the number of biopsies performed. By detecting more cancers earlier, the scans could also help reduce the need for further treatment.
Helping to end the ‘postcode lottery’
Specialist MRI is already used in some hospitals across the UK, but according to Emberton it’s been a “postcode lottery” up until now. He hopes this decision will help to end the inconsistency.
“It’s just the beginning, there’s a lot that has to happen now to translate this recommendation into benefit for patients. But if it’s done well it will transform care,” he said.
But concerns were raised about how the recommendation could increase the number of scans ordered for men with suspected prostate cancer, as well as the number of NHS staff needed to operate the scanners and interpret the results.
Matt Case, policy manager at Cancer Research UK said: “It’s fantastic to see NICE recognise the benefits that offering a specialist MRI could have for men with suspected prostate cancer. But these benefits will only be realised if there are enough NHS staff to cope with the increased demand for this specialist MRI scan.”
“The NHS must consider changes like this when planning how many staff it will need in the future”