Thousands of men with suspected prostate cancer could be spared invasive procedures by being offered a simple, painless scan instead, a study suggests.
British researchers found that only MRI scans can accurately diagnose the disease in some cases.
Currently, men being examined for prostate cancer typically undergo a biopsy, a procedure in which a needle is inserted into the prostate to take a sample of tissue.
Below NHS According to best practice guidelines, men should first undergo an MRI to determine if this is actually necessary, as there is a small risk of serious infections and bleeding.
In practice, however, the limited scanner capacity and staff shortages mean that many men are still immediately referred for a biopsy.
‘We already treat patients based on imaging alone for a number of cancers, such as kidney and liver cancer, without first having them undergo an invasive biopsy,’ says Dr Alex Kirkham, consultant radiologist at University College. London Hopital.
‘This study suggests that prostate cancer could join that list in some cases.’
Dr. Kirkham added that if further research confirms the findings, thousands of men could avoid a “risky and uncomfortable” procedure.
Thousands of men with suspected prostate cancer could benefit from an MRI scan, researchers say
Prostate cancer is the most common cancer in men, with almost 58,000 diagnoses each year in Britain.
The findings come after the government’s decision in July to again reject proposals for a national prostate cancer screening programme, which would have offered regular PSA testing and MRI follow-up to men at higher risk.
Supporters, including champion cyclist Sir Chris Hoy, warned the move could condemn thousands of men to a preventable death – with estimates suggesting up to 9,000 deaths could be prevented every decade if screening were introduced.
Now researchers say MRI could help diagnose thousands of men more quickly, when their cancer is most treatable.
In the new study – published in the European Journal of Radiology – researchers looked at the scans of 880 men who attended the hospital’s one-stop clinic for suspected prostate cancer.
All men underwent a prostate MRI in addition to a blood test for PSA, a potential marker of cancer.
Radiologists then examined the scans and assessed how confident they were that a tumor was present.
Crucially, when doctors were 99 percent certain that a man had prostate cancer based on the MRI, the diagnosis was confirmed by a biopsy in all cases.
According to Prostate Cancer UK, prostate cancer is now the most common form of cancer in Britain
The Daily Mail campaigns to end unnecessary prostate deaths and supports prostate cancer screening for men at high risk of the disease
Even at slightly lower confidence levels, scans were found to be highly accurate in identifying significant cancers.
The team concluded: ‘There is a group of patients in whom prostate cancer is almost certain based on MRI findings.
‘In the future, this may allow treatment without the need for a biopsy.’
They added that reducing the reliance on biopsy for a carefully selected group of patients could mean faster access to treatment and less discomfort.
‘What surprised us was how confident we could call some of these scans, even when the tumors were small or the PSA levels looked unremarkable,’ said Dr Kirkham.
‘It tells us that some proportion of prostate cancers look really distinctive on MRI, an appearance that experienced readers can recognize with a very high degree of certainty.’
In the NHS, waiting for a biopsy – and its results – is the most common target across all cancer pathways, say doctors at UCLH.
For suspected prostate cancer, NHS best practice guidelines state that referral for MRI and biopsy should be within seven days of an urgent GP referral. But due to capacity limitations this often takes much longer.
‘This is important because the incidence of prostate cancer is only set to rise: a Lancet Commission paper projects that global cases will double by 2040, largely driven by an aging population,’ said Dr Mark Emberton, a consultant urologist at UCLH.
“Together, this push makes faster, more reliable ways to diagnose prostate cancer an urgent priority.”
Earlier this year, the National Screening Commission rejected proposals for a national PSA screening program.
Instead, screening is currently only offered to men who request a test or who are identified as high-risk.
The committee justified its decision on the grounds that expanding screening could lead to overdiagnosis and overtreatment, exposing some men to a risk of impotence and incontinence when their tumor was unlikely to cause problems during their lifetime.
