Millions could benefit from faster scan to diagnose prostate cancer – study

Millions of men could benefit from a faster scan to diagnose prostate cancer that could also save the NHS cash, researchers say.

The MRI scan takes just 15 to 20 minutes instead of 30 to 40 and is cheaper and just as accurate as current MRIs.

A new study on the scan, from University College London (UCL), University College London Hospital (UCLH) and the University of Birmingham, was published in the Journal of the American Medical Association (Jama).

Funded by the John Black Charitable Foundation and Prostate Cancer UK, it found that a two-part MRI could detect cancer at the same rate as a three-part MRI, which is the current standard of care and includes a third stage where a dye is injected into the patient.

The trial included 22 hospitals in 12 countries and included 555 patients aged 59 to 70.

Radiologists assessed the effect of a two-part scan without the dye, and separately assessed the three-part scan with the dye, for every patient in the study.

A prostate biopsy was done when required to confirm whether or not the diagnosis was correct.

Researchers found the quicker two-part scan was just as effective at diagnosing prostate cancer as the three-part.

In total, 29% of patients had cancer diagnosed by the shorter two-part scan, the same percentage as the longer three-part scan.

Associate Professor Veeru Kasivisvanathan, lead researcher from UCL and UCLH, said: “Currently around four million MRI scans are needed each year globally to diagnose prostate cancer.

“This demand is set to rise rapidly with a predicted surge in prostate cancer cases over the next 20 years.

“Time, cost and staff availability are all limiting factors in how many scans can be offered, which makes the results of (this) trial particularly important.

“If we can do the scan in up to half the time, with fewer staff and at lower cost, that will make a huge difference in allowing every man who needs a scan to be able to get one in a timely fashion.”

Associate Professor Francesco Giganti, from UCL and UCLH, said: “The three-part multiparametric MRI scan has been a game-changer for the diagnosis of prostate cancer, sparing thousands of patients unnecessary biopsies and improving cancer detection.

“Currently we inject a dye into the patient that highlights the presence of cancer on the MRI scan, but this step requires time and the presence of a clinician, and can on rare occasion cause mild side-effects.

“Being able to make accurate diagnoses without the contrast stage will reduce scan time, meaning we can offer scans to more men using the same number of scanners and operators.

“However, it is vital that the scans are of optimal diagnostic quality and that they are interpreted by a radiologist with dedicated expertise in prostate MRI.”

In the NHS currently, a three-stage MRI scan costs £2,733 on average whereas the two-stage scan is £145, researchers said.

Prostate Cancer UK’s Transform trial, the biggest prostate cancer screening trial for 20 years that will include MRI, is due to begin later this year.

The trial will find the best way to screen men for prostate cancer and could inform a national screening programme.

Dr Matthew Hobbs, director of research at Prostate Cancer UK, said the UCL findings were “a hugely important step in the right direction for making MRIs more efficient”.

He added: “Another trial is already happening in the UK and the results of the two trials together should provide the complete evidence package we need to change practice across the country.

“We encourage the National Institute for Health and Care Excellence to prepare to review their guidelines as soon as that evidence base is complete, so that we can make MRI quicker, cheaper and less onerous for men.”

Professor Freddie Hamdy, from the University of Oxford, and Jenny Donovan, from the University of Bristol, said there were limitations to the study, which were pointed out by the authors themselves.

They added: “What concerns us most is that the endpoint was the diagnosis of ‘clinically significant disease’, defined as Gleason Grade Group 2 or higher.

“This definition is increasingly questioned as being flawed because it still represents overdiagnosis in many cases, which in turn leads to overtreatment.”

They said it was also possible NHS centres with less expertise will continue to request a further multiparametric MRI to guide treatment decisions.

“This would represent an increased cost and burden to health systems and would need to be monitored and investigated further in addition to addressing training issues, quality control, health economics and developing the potential role of AI in the future mentioned by the authors,” they said.

Ben Lamb, consultant urological and robotic surgeon, from Queen Mary University of London, welcomed the study, adding: “Without doubt, the current advice on assessing men’s prostate cancer risk and PSA testing needs to be revised.

“However, we should not rush into a national screening programme without carefully considering the most effective way of doing it, and also the impact of resource allocation on other areas of healthcare.”

The two-part scan involves imaging to create a very detailed picture of the anatomy of the prostate, showing its different zones and whether something looks abnormal in shape or texture. Cancer usually appears darker.

The second part looks at how water molecules move inside the tissue. Cancer usually makes tissues more packed so water moves less freely.