Each year, up to 100,000 men are suspected of having prostate cancer, 46,000 men are diagnosed, and 11,000 men die from the disease.
March is Prostate Cancer Awareness Month and there has been a timely development in the method of diagnosing prostate cancer. The breakthrough has been described as the biggest advance for decades in diagnosing the disease.
The traditional approach for diagnosing prostate cancer at NHS hospitals is to perform invasive prostatic biopsies in patients who have elevated prostate specific antigen (PSA) levels. The problem with this approach is that the true nature and extent of the cancer may not be accurately diagnosed, as biopsies may not target the most affected area of the prostate. In some cases, the disease may not be serious or require treatment but, because of the limits of the method of diagnosis, patients are commonly over-diagnosed and over-treated. Those patients then undergo treatment that is avoidable and which may cause harm. Two common but serious side effects of treatment for prostate cancer are incontinence and impotence.
A recent study, however, which involved MRI diagnosis of prostate cancer, has found that MRI scans are twice as effective at diagnosing the presence of prostate cancer. This has been heralded as a breakthrough method which will enable patients to be treated appropriately for the aggressiveness of their disease and prevent them being over-diagnosed and over-treated.
Hashim Ahmed, who led the first trial of MRI diagnosis at University College London, said: “Our current biopsy test can be inaccurate because the tissue samples are taken at random. This means it cannot confirm whether a cancer is aggressive or not and can miss aggressive cancers that are actually there.” In the study led by Mr Ahmed, of 576 men with raised PSA levels, two fifths were diagnosed with prostate cancer. The traditional method of biopsy identified the cancer in 48% of patients with cancer, whereas the multi-parametric MRI scan identified cancer in 93% of those with the disease.
The study shows that the proposed method of MRI diagnosis will take place in two stages. Patients with elevated PSA levels will first undergo an MRI scan to identify whether prostate cancer is present. Those patients who do not have prostate cancer on MRI imaging will avoid the invasive biopsy procedure. The MRI imaging will allow the biopsies to be more targeted and will better enable the true extent and nature of the disease to be diagnosed.
Mr Ahmed estimates that 25% of men who undergo a biopsy each year would not need one if they had an MRI scan first. For those who are diagnosed with prostate cancer on MRI investigation, targeted biopsies will enable 50% more aggressive cancers to be diagnosed each year. This may ultimately result in fewer prostate cancer related deaths.
The majority of NHS hospitals currently do not use MRI to diagnose prostate cancer because they do not have enough scanners or radiologists to interpret the results. The NHS watchdog is now reviewing whether diagnosis guidelines should be changed.
Arran Macleod, a solicitor in the clinical negligence team at Penningtons Manches, said: “It seems there is a clear benefit in performing a two stage investigation to diagnose prostate cancer. The MRI scan, combined with prostate biopsies, appears to have a far higher diagnostic ability than biopsy alone, which means that some patients will be spared invasive and potentially harmful treatment, while others will benefit from a more appropriate treatment plan for the aggressiveness of their cancer.
“In our work we see the physical symptoms suffered by patients who have been treated for prostate cancer when that treatment was unnecessarily performed. We also see the stress and anxiety caused to patients who have had their prostate cancer undertreated, or treated late, due to the current method of diagnosis. We therefore welcome the new two-stage method of diagnosis, which we expect to increase the accuracy of diagnosis and improve patient safety.”