Pinpoint scanner eases agony of prostate biopsies

AMACHINE that checks for prostate cancer with pinpoint accuracy has been tested on UK patients for the first time. The UroStation uses l i ve 3D images to highlight areas of diseased tissue and indicate where a biopsy sample should be taken.

Doctors can then diagnose correctly what stage the cancer has reached — and immediately decide on the best treatment.

The £100,000 kit is being hailed as a major step forward in testing for a cancer that is now the most common among men in the UK. It means that by taking a biopsy more accurately, doctors can spare patients the discomfort and distress of repeat biopsies, as well as the risk of unnecessary surgery which comes with potentially debilitating sideeffects such as incontinence and impotence.

The machine ‘fuses’ images of the tumour taken by an MRI scanner with live ultrasound images of the prostate. Doctors use the resulting 3D map to guide the biopsy needle to the tumour’s exact location.

With standard biopsies, some studies suggest that those done without an MRI completely miss tumours in one in five men — other research suggests as many as one in two tumours are not picked up.

This sophisticated scan improves the odds of men beating the disease by speeding up diagnosis, according to Pardeep Kumar, the surgeon who has tested the UroStation on more than 30 patients to date at the Royal Marsden Hospital.

‘ Early diagnosis i s key to improving patient outcomes so this piece of kit has huge potential to make a real difference,’ he says.

‘With this new testing system you can nail the location of the tumour like hitting the bull’s eye on a dartboard.’

Every year more than 40,000 new cases of prostate cancer are diagnosed. Yet many more cases go undetected. The disease develops slowly and men can be without symptoms for years.

The first step for diagnosing prostate cancer is a blood test.

This checks for prostate specific antigen (PSA), a protein produced by the prostate — raised levels can be a sign of cancer. But they can also be a sign of other noncancerous conditions such as an inflamed or enlarged prostate.

So the next step for men with an elevated PSA score is usually a rectal examination, followed by a biopsy where the doctor inserts a needle via the rectum into the prostate gland.

Not only is a biopsy an unpleasant experience, but the results are often unclear. The cancer is frequently hard to find when there’s no visual image to guide the doctor to its exact location — this means the biopsy has to be repeated, sometimes several times.

Mr Kumar explains: ‘It’s not always conclusive as we are inserting needles with no visual image of the prostate.

‘In a third of cases, we need to repeat the biopsy if we didn’t get enough tissue, which can be distressing for patients. Multiple biopsies can scar the prostate and there’s a risk of infection every time.’

A welcome advance in testing has been the use of Magnetic Resonance Imaging (MRI). An MRI scan provides exceptionally clear i ma ge s , which reveal any tumours present and their location so the doctor knows where to take tissue samples from.

This has been a breakthrough by saving doctors f r om r elying on g uesswork when doing a biopsy. It also spares the patient from an unnecessary biopsy — this is only done i f the MRI detects an abnormal shadow.

However, there are limitations with an MRI scan. It cannot be carried out at the same time as a biopsy — an MRI produces its images using a powerful magnet, which would rip the steel biopsy needle out of the body.

THE process of taking a biopsy after an MRI can now be even more accurate with the addition of live ultrasound images, which help doctors guide the biopsy needle into the right place as it’s being done.

First the patient has an MRI and their results are analysed. Patients whose scan results show a dark shadow on the image ( i ndicating a t umour) are referred f or an UroStationguided biopsy.

The MRI images are uploaded on to the UroStation machine and the doctor marks them up to show the tumour location.

The patient is given a local anaesthetic, an ultrasound probe with a needle attached is inserted into their rectum and this probe sends back pictures of the prostate as live 3D images — similar to those used with baby scans.

These ultrasound pictures are combined with the MRI data on the same screen so the doctor can check they are guiding the biopsy needle into the right place. The biopsy sites show up as red markers on the UroStation screen. One of the first patients to benefit from the UroStation, which has been funded by the Royal Marsden Charity, i s Paul Ashworth, 59, the owner of a waste recycling business. The results of his annual medical last June revealed his PSA levels were elevated (4.1). His GP repeated the test a month l ater and referred him to Mr Kumar, who carried out an MRI test. This showed up a darkened area on his prostate. He then underwent a bi opsy using t he UroStation. This revealed his cancer was close to the edge of his prostate gland and was aggressive.

‘I’ve been very lucky,’ says Paul. ‘ It was clearly not far away from spreading to my lymph nodes.’

‘It was a shock to hear that I needed my entire prostate gland removed but I knew that the test was so precise — they’d got a good sample — that it was an obvious decision to go ahead.’

He had t he s urgery in November, and his PSA levels are now zero. ‘I’ll need PSA tests every three months for the next two years but essentially the prognosis is good.’

A machine like the UroStation could help prevent some of the 10,000 deaths of men f rom prostate cancer that occur every year, according to Roger Kirby, professor of urology at t he University of London and director of The Prostate Centre clinic.

‘If an MRI is not done before the biopsy, the cancer can be missed completely.

‘There can then be many months, or even years, delay before another biopsy is arranged,’ says Professor Kirby, who survived prostate cancer thanks to an MRI scan.

‘Lives may be lost because the cancer progresses in the interim’

HOWEvER, he points out MRI scanners are in scarce supply in the NHS and there is also a shortage of radiologists with the expertise to interpret scan results accurately.

‘ Te ch n o l o g y such as UroStation creates the potential to reduce unnecessary biopsies and improve the accuracy of a biopsy — it means men could be cured. But they’re being denied that possibility because we haven’t got the kit,’ he says.

‘ Prostate cancer is n’ t a priority, unlike breast cancer or dementia. Women would kick up a fuss if they couldn’t get accurate mammograms.

‘We need to campaign for more awareness about prostate cancer, better facilities and more accurate diagnosis.

‘I’m one of the people who got saved but there are 10,000 men out there dying unnecessarily every year.’