Variations in access to pre-biopsy MRI
Access to multiparametric MRI (mpMRI) before a prostate biopsy is patchy around the UK and in some areas scans are not being offered at all. Based on a freedom of information request by Prostate cancer UK (PCUK), only 57% of areas across the UK are providing high quality mpMRI before biopsy. In some areas men have no access to mpMRI before biopsy, particularly in North and West Wales, Northern Ireland, parts of North West England and parts of Scotland.
The data comes 18 months after the PROMIS trial showed mpMRI before a biopsy could increase detection of prostate cancer and reduce unnecessary biopsies.
PCUK is calling on NHS decision makers in the areas which are offering no access, to prioritise the service transformation needed to make pre-biopsy mpMRI available without delay. It is also calling on NHS decision makers across the whole of the UK to address the variation in the level and quality at which it is being made available.
Heather Blake, Director of Support and Influencing at PCUK says: ‘This groundbreaking diagnostic tool is the biggest leap forward in prostate cancer diagnosis for decades and it is therefore appalling that health officials in some areas are still not seeing this as a priority. We urge health departments and commissioners in the worst offending areas to step up and focus their efforts on getting mpMRI before biopsy to men without delay.’
According to PCUK some areas are providing mpMRI before biopsy but not using the Dynamic Contrast Agent used in the PROMIS trial which provides increased scan accuracy. Using the dye adds additional time to the scanning process. Other areas are using age or PSA level criteria to restrict access.
A best practice consensus from clinical specialists on implementation of mpMRI before biopsy has just be published in the British Journal of Urology International (doi.org/10.1111/bju.14361).
Dr Shonit Punwani, Director of Clinical Imaging at University College London and consensus panel member says: ‘Performing an mpMRI scan before biopsy can offer men with prostate cancer a more accurate diagnosis, and can help avoid biopsy. However, it is a complex imaging technique that, if not performed to certain standards, will result in men incorrectly being told that they do not have prostate cancer, or men being sent for biopsies that they do not need. Men need to be confident that wherever in the UK they receive a scan, they are receiving a high-quality procedure which will be safely and accurately interpreted.’