Wales ‘lagging behind’ in offering cancer test
WALES is lagging behind other parts of the UK in offering a “breakthrough” diagnostic test for patients with prostate cancer, it is claimed.
A Freedom of Information (FOI) request from Prostate Cancer UK found that just three out of seven Welsh health boards are providing a multi-parametric magnetic resonance imaging (mpMRI) scan before a biopsy.
This is a special type of scan that creates more detailed pictures of your prostate than a standard MRI scan.
Out of those three, only Aneurin Bevan and Cwm Taf University Health Boards are providing mpMRI to a high enough standard to safely rule men out of biopsy.
Prostate Cancer UK say this represents no improvement since the health boards last responded to an FOI on this in autumn 2016.
The level of provision compares poorly to England where the majority (92%) of areas are providing mpMRI before biopsy and 60% are providing to a high standard.
The FOI comes 18 months after the PROMIS trial first proved the mpMRI before a biopsy could radically boost detection of prostate cancer.
Prostate Cancer UK is calling on the Welsh Government and health boards to take urgent action to end this variation in access.
Heather Blake, director of support and influencing at Prostate Cancer UK, said: “It is appalling that men in Wales should be denied the more accurate prostate cancer diagnosis that is becoming increasingly available to men in other parts of the UK.
“The evidence in support of mpMRI before biopsy is overwhelming – it is the biggest breakthrough in prostate cancer diagnosis for decades. This inequality in access cannot be allowed to continue.
“We want the Welsh Government and commissioners in Wales to take the lead from counterparts in other parts of the UK and prioritise making pre-biopsy mpMRI available to a high standard across Wales as a matter of urgency.
“Prostate Cancer UK are ready and willing to provide support and insight to help drive the service transformation needed make this happen. Urgent action is needed so that men in Wales no longer miss out.”
Raymond Starr, from north Wales, visited his GP for a routine medical which revealed a slightly elevated amount of prostate specific antigen (PSA) in his blood.
The 63-year-old’s PSA levels continued to rise and eventually he was referred to have a TRUS biopsy which took 12 random samples from his prostate.
It was recommended that he have an mpMRI scan to provide a much more detailed picture of the prostate gland.
However, Raymond was told that he would have to pay for the scan because it is not available on the NHS in north Wales.
He said: “I didn’t feel as though I had much option. My life was in the balance and so obviously I decided to pay.”
Raymond paid £890 for an mpMRI scan at Spire Hospital in Wrexham, which confirmed that he did have prostate cancer. This had been missed by the previous TRUS biopsy.
“Thankfully my cancer was caught before it had a chance to spread to other parts of my body.
“But if it wasn’t for the mpMRI I could have been walking around totally blind to the danger that I was in because my previous biopsy had indicated that there wasn’t a problem.”
Following his diagnosis, Raymond opted to have a radical prostatectomy which took place in March. He also married his long-term partner, John.
“I’m lucky that I have a good doctor and I was able to pay for an mpMRI – thousands more in North Wales aren’t so fortunate. This has to change.”
In 2017 the Welsh Urology Board recommended for mpMRI before biopsy to be implemented to the PROMIS trial standard across Wales.
A clinical consensus has now been developed by experts with support from Prostate Cancer UK and published in the July edition of the British Journal of Urology International.
Cabinet Secretary for Health Vaughan Gething stated that he expected health boards to incorporate pre-biopsy mpMRI into their diagnostic pathways for prostate cancer if NICE updates its guidelines to recommend it.
However new NICE guidelines are not due until 2019 and will be based on already published evidence.
It is claimed waiting until 2019 will cause Wales to fall further behind the rest of the UK.
Mr Jim Wilson, chairman of the Welsh Urology Board, said: “The Freedom of Information data in Wales paints a disappointing picture.
“High-quality mpMRI before biopsy benefits patients through more accurate diagnosis and by safely ruling out unnecessary biopsies. Men in Wales should not be denied these benefits which are being made available to men in England.
“Waiting until April 2019 for the updated NICE guidelines will only cause Wales to fall further behind.
“The evidence is already published and now that additional support materials such as the clinical consensus are available there can be no further excuses for dragging their heels.
“I hope that urgent work can be done to ensure that all men in Wales are able to benefit from this technique in the future.”
In response, a Welsh Government spokesperson said: “The routine use of a multiparametric MRI scan before prostate biopsy is not currently recommended by NICE but they are reviewing the guidelines on this in light of new evidence.
“Once we know the outcome of the review by NICE, we would expect health boards to revise their diagnostic pathways accordingly.
“Health boards are already considering the potential impact of the revised guideline through the Wales Urology Board.”