19th June 2013
Laura Donnelly’s article (Daily Telegraph Sat 15th June) contains some factual inaccuracies. She estimates that if all men referred with suspected prostate cancer received an MRI scan prior to a prostate biopsy, a quarter of them could be reassured without the need for a biopsy. This is fundamentally misleading because as yet there is insufficient evidence to support this assertion.
The article further claims that an initial MRI could halve the number of men who would be diagnosed with significant cancer incorrectly by biopsy and subsequently receive unnecessary treatment.
Similarly, this has not yet been confirmed by rigorous clinical research. Validation, via the PROMIS trial – https://www.controlled-trials.com/ISRCTN16082556 is currently being undertaken at UCLH by Professor Mark Emberton’s team. Should evidence emerge of the usefulness of MRI in identifying men with prostate cancer the process would need to be standardised by protocols endorsed by The Royal College of Radiologists and significant training would need to be undertaken by radiologists nationally.
MRI scans are expensive, as each scan costs £400, thus there are significant resource implications. This diagnostic pathway would need to be funded by Primary Care Commissioners for both an initial scan plus any repeat scans that may be required if biopsy is not deemed necessary. Regretfully currently such funding is not confirmed.
BAUS fully supports all endeavours to improve the diagnosis and treatment of prostate cancer for men in the UK but evidence of effectiveness needs to be in place before new modalities can be introduced nationally.
Adrian D Joyce MS FRCS(Urol)
Consultant Urological Surgeon & Hon Senior Lecturer
St James’ University Hospital
Leeds LS9 7TF
President, British Association of Urological Surgeons
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