Researchers have been awarded £1 million to trial new MRI scanning methods to diagnose prostate cancer.

The team, from Imperial College London and Imperial College Healthcare NHS Trust, will explore whether a new type of magnetic resonance imaging (MRI) scan can detect signs of prostate cancer more quickly than current methods.  They will also assess whether new imaging technology to help doctors carry out targeted prostate biopsies is better at detecting prostate cancer compared to traditional biopsies. If proved effective, the team hopes the new technology will be more accurate and faster at diagnosing prostate cancer, and they estimate it could save the NHS £15 million per year.

Funded by Cancer Research UK, the work is led by Professor Hashim Ahmed, from the Department of Surgery and Cancer at Imperial College London, who is Consultant Urological Surgeon at Imperial College Healthcare NHS Trust. Prostate cancer is the most common cancer in men in the UK with around 52,300 new cases diagnosed each year. It develops when cells in the prostate grow in an uncontrolled way. Prostate cancer develops slowly and symptoms such as the blood in the urine do not appear until the disease has developed. It usually affects men over 50 and often men with a family history of the disease.  Black men are disproportionately impacted by the disease and deaths from prostate cancer have now overtaken those from breast cancer.

Diagnosing prostate cancer

One of the main methods to diagnose prostate cancer is a special type of magnetic resonance Imaging (MRI) scan called a multi-parametric MRI (mpMRI) scan, which helps doctors see if there is any cancer inside the prostate and how quickly the cancer is likely to grow.

The procedure involves an injection of a dye called gadolinium through a small plastic tube into a vein in of the arm. This helps to show up the body’s organs more clearly.   However, this method can have side effects such anaphylactic shock – a rare but severe allergic reaction – and the dye can get deposited into brain tissue.  The scan also takes 40 minutes and costs £350-450. Administration of gadolinium requires further medical supervision due to the risk of anaphylactic shock.  This puts extra pressure on staff resources and can lead to patients with suspected prostate cancer waiting longer to be seen.

One arm of the new trial will look at the effectiveness of using Bi-parametric MRI (bpMRI), a shorter type of MRI scan that uses the same device to image the prostate to detect signs of cancer.  Instead of 40 minutes, it takes 15 minutes and does not involve a gadolinium injection and costs £200. Previous studies have indicated that bpMRI might be as accurate as mpMRI in detecting prostate cancer.   However, these studies have involved a small number of patients.

New Methods

Professor Ahmed said: “Cases of prostate cancer are rising each year and it’s predicted that 250,000 men will be diagnosed with this disease every year by 2030.  MRI scans are one of the ways we detect prostate cancer but current scans are time-consuming and require a doctor to be present. About out one million MRI scans will need to eventually be carried out every year. Our trial will assess whether bpMRI, which is much quicker, can detect prostate cancer just as effectively as current scanning methods. If proved effective this new method could save the NHS money and allow for more men to be scanned.”

Men who have a suspicious MRI are referred for a biopsy, which involves using thin needles to take small samples of tissue from the prostate. This is then looked at under a microscope to check for cancer.  The current method relies on a doctor’s judgement to guide where to place the biopsy needle. This could mean that cancers are missed as samples may be taken from an area that does not contain the cancer.

The second part of the trial will use image fusion technology, which merges MRI and ultrasound images of the prostate to help identify the target area for biopsy. The technology is able to guide the biopsy needle to within two-three millimetres accuracy. Experts think that this technology might be more accurate at detecting prostate cancer than traditional methods but no large studies have previously been carried out to confirm this.

Professor Ahmed added: “Current biopsies require doctors estimating where to deploy the biopsy needle in order to take tissue samples.  This means a section of tissue may be taken that does not show the cancer and it might be missed. Therefore, we need to look at methods that can improve the accuracy of biopsies.  We will also look at whether image fusion technology could lead to improved detection of prostate cancer. We need to be sure about the value of image fusion for the NHS, as it will cost a lot of money to buy the technology for every hospital.

“The funding for these trials will allow us to test these new methods and see whether they could help improve the ways in which we detect and diagnose this disease so we can help more men.”

PACIFIC Trial

Professor Ahmed and his team will recruit up to 3,600 men to the Prostate Assessment using Comparative Interventions – Fast mri and Image-fusion for Cancer (PACIFIC) trial at Charing Cross Hospital, part of Imperial College Healthcare NHS Trust.  Up to 30 NHS hospital will also take part. The PACIFIC trial will assess whether bpMRI can be just as effective at detecting signs of prostate cancer as mpMRI. The team will randomise the men into two groups; one will receive a bpMRI and the other a mpMRI.  The second part of the trial will focus on the men who have a suspicious MRI and require a biopsy.  These men will be randomised into two groups; these men will receive a traditional biopsy or a biopsy using image-fusion technology.  The team will then compare the results from the different groups.

For more information on the PACIFIC trial please visit Imperial Prostate.