Some prostate cancers ‘can be diagnosed without biopsy’ – study

Of the 69 patients deemed to be '99% certain' they had a tumour via their MRI scan, all of them (100%) had cancer confirmed through biopsy. Stock picture

Some prostate cancers can be diagnosed without the need for an invasive biopsy, according to a new study.

For some men, cancer can be detected through an MRI scan alone with a high degree of certainty, according to experts from University College London Hospitals (UCLH).

In many hospitals, men with suspected prostate cancer will be referred for a magnetic resonance imaging (MRI) for detailed images of what is happening in the body. Depending on the images, doctors may also recommend a biopsy.

In other hospitals, those with suspected cancer will be referred straight for a biopsy — where a small needle is put into the prostate to take a tissue sample so it can be checked for cancer cells.

There are two different types of biopsy for prostate cancer, with needles inserted in different places depending on the type chosen.

Samples taken are then examined under a microscope to check for cancerous cells.

There are a number of advantages and disadvantages for having a biopsy, with the disadvantages including side effects; missed cancers and the detection of non-aggressive or slow growing cancers which may not need treatment.

But the new study found that some men may not need to have this procedure done and could have their cancer diagnosed by MRI alone.

The research looked at 880 men who attended UCLH’s one-stop clinic for suspected prostate cancer over a one-year period.

All of the men had a prostate MRI.

Four experienced radiologists looked at scan results combined with the patient’s age and their prostate-specific antigen (PSA) score.

Some 251 were deemed likely to have a tumour and 217 of these went on to have a biopsy.

The radiologists examined each scan and were asked to say whether they were “99% certain” there was a tumour, “90% certain” or less than 90% certain”.

Of the 69 patients deemed to be “99% certain” they had a tumour via their MRI scan, all of them (100%) had cancer confirmed through biopsy.

Some 45 patients were scored as “90% sure” they had a tumour.

Of these 41 underwent biopsy and 40 (98%) had significant tumour.

Researchers said this indicates that certain men may not need to have invasive biopsies, and their cancers could be confirmed with a scan alone.

“There is a group of patients in whom prostate cancer is close to certain based on MRI findings,” the authors wrote in the European Journal of Radiology.

“In future this may enable treatment without the need for biopsy.” Experts said that reducing reliance on biopsy for a carefully selected group of patients could mean faster access to treatment and less discomfort.

UCLH consultant radiologist Alex Kirkham said: “For a number of cancers, we already treat patients on the strength of imaging alone, without putting them through an invasive biopsy first.

“This study suggests prostate cancer could, in some cases, join that list.

“If we can confirm these findings in larger, multi-centre studies, it could mean some men reach treatment faster and avoid a procedure that, while generally safe, is not without risk or discomfort.

He added: “What surprised us was how confidently we could call some of these scans, even when the tumours were small or PSA levels looked unremarkable.

“It tells us that a proportion of prostate cancers have a genuinely distinctive appearance on MRI, one that experienced readers can recognise with a very high degree of certainty.” 

UCLH consultant urologist and UCL professor of interventional oncology Mark Emberton said: “Globally, around 4m-5m prostate biopsies are carried out each year, yet in the NHS, the wait for a biopsy and its results is the most commonly breached target across all cancer pathways.

“This matters because prostate cancer incidence is only set to rise: A Lancet Commission paper projects that global cases will double by 2040, driven largely by ageing populations.

“Together, these pressures make faster, more reliable ways of diagnosing prostate cancer an urgent priority.” 

Dr Matthew Hobbs, director of research at Prostate Cancer UK, said: “Avoiding unnecessary biopsies is an important goal in prostate cancer care, because they can be painful, invasive and can cause infections.

“Our existing research is making significant progress towards reducing biopsies for men who don’t have prostate cancer, but this exciting paper is a first step suggesting we might also be able to reduce the burden on men who do have cancer.

“Using MRI alone to diagnose these cancers could make the process much safer and easier for men, and less costly for the NHS.

“These early results show there is an avenue to explore here which could deliver impact for men with prostate cancer, but this approach now needs to be tested robustly to understand exactly if and how it might work.

“As it stands biopsies remain a vital part of diagnosis and also provide important information that can help guide treatment decisions and future research.”