London Bridge Hospital introduces ‘Precision Prostate Diagnostics’ to determine individual risk in each patient
Prostate cancer is now the most common form of cancer for men in the UK, with over 40,000 men diagnosed every year. Unlike many other cancers, prostate cancer is slow growing, in fact most men will have evidence of prostate cancer by the time they reach their 80s. However, despite its slow progression in most men, it is vital that signs or symptoms of prostate problems, such as difficulty or painful urination are not ignored, early diagnosis, as in most cancers is key. Diagnosing prostate cancer at its earliest stages can provide the opportunity for definitive cure, using minimally invasive techniques minimising side effects.
London Bridge Hospital is continually developing its medical offering and is proud to introduce their latest service - “Precision Prostate Diagnostics” assessment, which is set to improve the pathway for diagnosing prostate cancer by determining individual risk and specifically identifying who most needs a biopsy or who can be safely reassured.
For the last 25 years the typical pathway for prostate cancer diagnosis has been unchanged. It is based around an elevated PSA (Prostate Specific Antigen) blood test, a rectal examination and an uncomfortable Trans-Rectal Ultrasound (TRUS) guided biopsy. Unfortunately although these tests are prostate specific, they are inaccurate, the PSA blood test is not a prostate cancer specific test, elevated levels of PSA may simply indicate in 30% an enlarged prostate but not prostate cancer. Additionally, although trans-rectal biopsies are the most commonly used method to try and determine whether an individual has prostate cancer, there is a false negative rate of over 30%. Mr Rick Popert, Consultant Urological Surgeon at London Bridge Hospital considers an inbuilt error of 30% is unacceptable for a modern diagnostic pathway, “The standard pathway risks both under diagnosis and misdiagnosis leading to both overtreatment (unnecessary radical surgery) or under treatment (from false reassurance).”
London Bridge Hospital’s “Precision Prostate Diagnostics” assessment takes an entirely new approach to diagnosis by resolving the uncertainty. Patients are referred, as before, with an elevated PSA following a routine medical but they undergo a comprehensive prostate assessment, completing a prostate health questionnaire, an evaluation of their urinary system and a diagnostic 3 Tesla MRI scan to assess the prostate more accurately before any decision is made about the need for a biopsy. Following the initial consultation and MRI scan result which can be combined in one visit, the surgeon and the patient are in a much better position to decide on the need for a prostate biopsy and also the very best method to carry out a precision targeted biopsy. The problem is the MRI may identify a small lesion within the prostate that cannot be seen on the ultrasound (the imaging modality used to take the biopsy). With modern computer software the static images of the MRI with the lesion identified can be “fused” with the live ultrasound to provide precision-targeted biopsies of the prostate. This has improved cancer pick up rates from around 40% of cases to 65% of cases. The information can be used to select patients for active surveillance safely, targeted focussed treatments such as brachytherapy or nerve sparing robotic surgery in the more aggressive cases.
Discussing the “Precision Prostate Diagnostics” assessment in more detail, Mr Rick Popert notes, “Precision Prostate Diagnostics provides better individualised assessment and treatment for prostate cancer. The recent acquisition by London Bridge Hospital of a new 3T MRI scanner will enable us to enhance our service further. The improved image quality and ability to “fuse” the 3T MRI images with “live” ultrasound provides the most precise method to target specific areas within the prostate. Unlike the traditional pathway, Precision Prostate Diagnostics shows us the exact location of any suspicion lesions within the prostate before we do the biopsies. It means we can better target the abnormality, minimising unnecessary biopsies of normal prostate tissue and optimising the sampling of the abnormal or suspicious prostate. If a prostate biopsy is needed, ideally, it should be done once and once only. This technology helps us to resolve the uncertainty of PSA testing, it provides reassurance to many and accurate diagnosis and treatment to those at risk from prostate cancer progression”