A BRC researcer and his team have suggested that using MRI imaging before deciding whether to carry out a biopsy on patients with suspected prostate cancer may lead to improved outcomes for men with the disease.
The team, led by Professor Mark Emberton, Professor of Interventional Oncology at UCL and a BRC-supported researcher, points out that there is limited evidence of the benefit of treating prostate cancer with surgery.
The researchers suggested that imaging all men with MRI and carrying out an MRI-targeted biopsy in those with an MRI lesion so that patients without suspicion of significant cancer would avoid a prostate biopsy, could lead to substantial health improvements.
The researchers, who are from UCL and the London School of Hygiene and Tropical Medicine, presented their initial modelling work at the National Cancer Intelligence Network Cancer Outcomes Conference in Brighton this month.
They argued that, despite 40,000 men being diagnosed every year with prostate cancer, little is known about the clinical effectiveness of the current diagnostic approach and how this might compare to the alternative of using imaging upfront.
Prostate cancer is the most common cancer in men, causing 10,000 deaths of the 40,000 men affected. Currently, more than 100,000 biopsies a year are carried out on men with suspected prostate cancer.
The team used a decision tree to draw together the best available evidence in order to compare a simplified version of the standard diagnostic pathway with a new pathway (MRI for all, then MRI-targeted biopsy if positive). They considered the prevalence of clinically significant prostate cancer to be 50% based on a multi-centre retrospective analysis of template prostate mapping biopsy data.
Diagnostic data for prostate cancer biopsies is limited; the gold standard, pathological data, is only available for men who go on to have surgery. Template mapping (TPM) biopsy is often used as a reference test in the absence of pathological data.
Given a prevalence of clinically significant prostate cancer of 50%, the use of a triage MRI followed by MRI-targeted biopsy in a hypothetical cohort of 1,000 men could avoid biopsies in 250 men compared to the current pathway, they argued. Definitive evidence on how accurate MRI is in diagnosing prostate cancer will come from the UCLH/UCH led study called PROMIS which is led by Mr Hashim Ahmed (MRC Clinician Scientist) and Professor Emberton and funded by the NIHR-HTA and run by the Medical Research Council Clinical Trials Unit.
The team’s presentation was based on an initial health economic model developed as part of work within the ‘SmartTarget’ project, conducted by UCL and the London School of Hygiene and Tropical Medicine and funded by the Wellcome Trust as part of the Healthcare Innovation Challenge Fund. The purpose of the device is to ensure information on the location of cancer from medical imaging is at the centre of the diagnosis and treatment of prostate cancer. Doctors are presented with a picture combining information from MRI with information from ultrasound images - which are then fused - allowing them to identify and target the cancer on a computer screen in a similar way to a fighter pilot presented with a target on a head-up display. This study is jointly led by Professor Mark Emberton and Dr Dean Barratt of UCL’s Centre for Medical Image Computing.
The objective is to develop and test the prototype SmartTarget device on patients, to develop and to introduce the technology within the NHS (and potentially other healthcare systems) within a 5 year period.
