Men with prostate cancer could skip biopsies and get straight on with treatment according to a new study. Research by University College London Hospitals (UCLH) showed that some patients can get a reliable diagnosis just from looking at magnetic resonance imaging (MRI) scans.
Study details and findings
A trial of 880 men who received MRI scans at an NHS one-stop clinic for suspected prostate cancer showed that experienced radiologists could diagnose a significant proportion of men with 100% accuracy without the biopsy. Radiologists looked at MRI scan results combined with the patient's age and their prostate-specific antigen (PSA) score. Some 251 were deemed likely to have a tumour over the one-year trial period and 217 of these went on to have a biopsy.
The radiologists examined each scan and were asked to say whether they were "99% certain" there was a tumour, "90% certain" or less than 90% certain. Of the 69 patients deemed to be "99% certain" they had a tumour via their MRI scan, all of them (100%) had cancer confirmed through biopsy. Some 45 patients were scored as "90% sure" they had a tumour. Of these 41 underwent biopsy and 40 (98%) had significant tumour. The findings are published in the European Journal of Radiology.
Expert comments and implications
UCLH consultant radiologist Alex Kirkham said: "There is a group of patients in whom prostate cancer is close to certain based on MRI findings. In future this may enable treatment without the need for biopsy. If we can confirm these findings in larger, multi-centre studies, it could mean some men reach treatment faster and avoid a procedure that, while generally safe, is not without risk or discomfort."
Dr Kirkham added: "What surprised us was how confidently we could call some of these scans, even when the tumours were small or PSA levels looked unremarkable."
Biopsies are routine NHS procedures but patients can face delays getting them and there is a risk of side effects such as infection. The procedure involves removing a piece of the suspected tumour site via a needle inserted through the rectum or perineal area. Samples taken are then examined under a microscope to check for cancerous cells.
Broader context
UCLH consultant urologist Professor Mark Emberton said: "Globally, around five million prostate biopsies are carried out each year, yet in the NHS, the wait for a biopsy and its results is the most commonly breached target across all cancer pathways."
Current NHS practices mean that in some hospitals men with suspected prostate cancer will be referred for an MRI and, if suspicions persist, will then be referred for a biopsy. In other patients men with suspected prostate cancer are referred straight for a biopsy.
Dr Matthew Hobbs, director of research at Prostate Cancer UK, said: "Avoiding unnecessary biopsies is an important goal because they can be painful, invasive and can cause infections. Our existing research is making significant progress towards reducing biopsies for men who don't have prostate cancer, but this exciting paper is a first step suggesting we might also be able to reduce the burden on men who do have cancer."
Earlier this year health chiefs rejected calls for more men to get routine prostate cancer tests. The UK National Screening Committee warned routine testing causes many to needlessly go under the knife and has refused to check the more at risk, such as Black men and those with a family history. The UKNSC said wider screening would not reduce deaths overall but did recommend it for "a few thousand" men with the BRCA gene.
