New scanning techniques for prostate cancer

07 March 2017

Spire Southampton consultants and hospital are involved in ground breaking research into new scanning techniques for prostate cancer detection. The recent trial showed that 27% of the men with high PSA levels did not need a biopsy at all. It also showed that 93% of aggressive cancers were detected by using the MRI scan to guide the biopsy, compared with just 48% when the biopsy was done at random.

The trial on 576 men, published in the Lancet, used multi-parametric MRI scanning on men with high PSA levels. The results showed more than a quarter could be spared invasive biopsies, which can lead to severe side-effects, and the number of aggressive tumours caught almost doubled.

Mr Tim Dudderidge, consultant urologist at Spire Southampton Hospital and University Hospital Southampton, was also involved in this landmark study. He comments:

“The patients from University Hospital Southampton were the third largest group contributing to this study and they all underwent their MRI scans at Spire Southampton Hospital. The findings from this study will, and already are playing a major role in the diagnosis of prostate cancer in men.  Whilst undertaking this study, we developed the skills to interpret the scans and we adopted this method, with this care pathway for our patients and have been using it since March 2014.

“It reduces the need for our patients to undergo an unnecessary biopsy by about 25%. Furthermore, we hope to reduce the number of men over-diagnosed with cancer – ie diagnosed with a cancer that does not go on to cause any harm during their lifetime.”

Consultant urologist, Mr Jonathan Dyer, explains:

“It was very exciting to be one of the centres contributing to the study, we have long believed that multi-parametric MRI (MPMRI) scanning has a role to play for men with high PSA or an abnormal rectal examination, and we introduced MPMRI as the first investigation in our pathway for these patients in about 2012.

“The images are better if the scan is performed first before the biopsy. For me it was common sense to do imaging before an invasive biopsy, but the problem in the past was that standard MRI was not accurate enough to be useful in diagnosis. It was therefore reserved for staging after the biopsy.

“This study confirms that MPMRI reported by experienced uro-radiologists is very accurate at detecting significant prostate cancer, and therefore supports what we have been doing already. The study also shows how MPMRI can differentiate significant cancer from insignificant cancer. This is an area which is really exciting, as it is the first test which has the capability of safely ignoring the insignificant disease and therefore reducing over diagnosis.

I have a number of patients who have elected to avoid a biopsy and we have performed MPMRI at intervals to monitor their prostates. This study provided evidence for this practice as a valid method of monitoring patients with an elevated PSA”.

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