Southampton study could revolutionise diagnosis of prostate cancer

Tim DudderidgeSurgeons at Southampton’s teaching hospitals are participating in a nationwide trial that could revolutionise the diagnosis of prostate cancer.

The Prostate MRI Imaging Study (PROMIS), which has been running since a pilot phase was completed at two sites in the UK in 2012, will discover if the use of advanced MRI scans can detect the condition without the need for invasive biopsies.

Traditionally, men with suspected prostate cancer have a blood test and, if a higher level of protein is found – known as prostate-specific antigen (PSA) – they are referred on for a transrectal ultrasound (TRUS) guided biopsy.

This is performed under local anaesthetic and involves using an ultrasound probe to guide a needle through the walls of the rectum and into the prostate gland to take samples. 

But as the ultrasound cannot always reliably identify the disease, it can miss some cancers or lead to over-diagnosis, frequently resulting in unnecessary surgery.

However, the latest imaging technology, known as multi parametric (MP) MRI, can produce accurate and detailed scans that could make it easier to identify whether or not a patient has cancer and, if so, the specific size, position and aggressiveness of it. 

This could enable clinicians to either rule out the need for further testing or, if cancer is found, give a clearer understanding of which part of the prostate is affected.

“Currently, all men with a raised PSA or abnormal feeling prostate are advised to have a biopsy, though many will not have cancer but another condition which raises PSA levels in the blood such as enlarged prostate,” explained Tim Dudderidge, a consultant urological surgeon at Southampton General Hospital.

“But these biopsies can miss cancers in some areas of the prostate which the needle cannot reach, or pick up tiny traces of cancer that might be slow-growing and harmless, leading to men having unnecessary surgery to remove the prostate gland.”

Mr Dudderidge is now working with colleagues at another nine sites across the country to recruit 700 men with suspected prostate cancer for the study by October 2015.

“If, as we think, the study shows us that (MP) MRI can accurately identify those who have cancer and those who don’t, it will truly revolutionise diagnosis for men with prostate cancer,” he said.

“It will mean those with a negative scan will avoid undergoing potentially painful and invasive biopsies, while those with positive scans will benefit from their specialists having much greater detail of their cancer at the earliest possible stage.”

Those who take part will have a scan performed by radiographers at Spire Southampton Hospital before also undergoing a biopsy at Southampton General.

Mr Dudderidge added: "Although men taking part in this trial will not benefit from an MRI alone as they will still need a biopsy, it offers them the most accurate diagnostic testing currently possible anywhere in the world."

Prostate cancer, which mainly affects men over 50, is the most common type of cancer in men with around 37,000 new cases diagnosed in the UK every year.

Posted on Tuesday 25 November 2014