The Scottish Mail on Sunday

Scan that helps men avoid risky prostate biopsy

- By Carol Davis

MEN with sus­pected prostate can­cer could be spared painful and risky nee­dle biopsy tests thanks to a new scan­ning tech­nique that can de­tect tu­mours just as ac­cu­rately, a new study has found.

Cur­rently, if doc­tors be­lieve a man is suf­fer­ing symp­toms that in­di­cate the dis­ease, he will first be of­fered a blood test that looks for raised lev­els of prostate spe­cific anti­gen (PSA), a pro­tein pro­duced by the prostate gland.

Al­though a higher-than-nor­mal PSA level may be caused by can­cer, it can also be the re­sult of other be­nign con­di­tions.

How­ever, about 150,000 men a year will then have a tran­srec­tal ul­tra­sound (TRUS) biopsy, where ten to 12 small tis­sue sam­ples are taken from the prostate via the rec­tum us­ing a nee­dle.

But this causes pain, which in some men can last for weeks. It can also cause bleed­ing in the urine or se­men – and up to one in three men are treated for an in­fec­tion af­ter­wards.

A less in­va­sive ap­proach is be­ing rec­om­mended af­ter the Prostate MRI Imag­ing Study (PROMIS), in which 740 men with blood tests that in­di­cated prostate can­cer were of­fered a spe­cial type of MRI scan.

A quar­ter of the men were ei­ther di­ag­nosed with can­cer or given the all-clear, mean­ing they could safely avoid a biopsy.

For those men who did still need a biopsy, just hav­ing a de­tailed scan of the prostate in ad­vance meant that doc­tors could take sam­ples from the sus­pect ar­eas and im­prove ac­cu­racy.

Pro­fes­sor Raj Per­sad, con­sul­tant urol­o­gist at North Bris­tol NHS Trust who took part in the study at South­mead Hos­pi­tal, said: ‘Ac­cu­rate treat­ment of prostate can­cer de­pends on ac­cu­rate di­ag­no­sis, but PSA lev­els can vary widely and are af­fected by prostate size, age, re­cent surgery, how re­cently a man has had sex, and even cy­cling, so they are a very in­ac­cu­rate guide.

‘And a TRUS biopsy ef­fec­tively takes tis­sue sam­ples at ran­dom, and so may miss a can­cer en­tirely so we may give a pa­tient the all-clear when they ac­tu­ally have a clin­i­cally sig­nif­i­cant can­cer.’

Prostate can­cer is the most com­mon can­cer among men in the UK, with 47,000 new cases di­ag­nosed an­nu­ally. About 11,000 men die of the dis­ease.

How­ever, thanks to ad­vances in treat­ment, the out­look is gen­er­ally good. Around 84 per cent of men with prostate can­cer sur­vive for more than ten years af­ter di­ag­no­sis.

Na­tion­ally, about half of men who are thought to have prostate can­cer have the spe­cial­ist scan –multi-para­met­ric mag­netic res­o­nance imag­ing, or MP-MRI – be­fore a biopsy.

While most ma­jor hos­pi­tals now have the right kind of scan­ning fa­cil­i­ties, prac­tice varies widely. Some of­fer this to all pa­tients be­fore biopsy, some to very few.

Tim Dud­deridge, con­sul­tant uro­log­i­cal sur­geon at Southamp­ton Hos­pi­tal, said: ‘Around a quar­ter of men could be spared a biopsy by proper scan­ning. Scans are be­ing of­fered in a hap­haz­ard way, and we need a stream­lined na­tional sys­tem to spare men un­nec­es­sary biop­sies.’

Newspapers in English

Newspapers from UK