‘Fusion’ imaging raises hopes of improving prostate cancer outcomes

The MULTIPROS study, led by Ghulam Nabi, Professor of Surgical Uro-oncology at the University’s School of Medicine, found that US/MRI fusion targeted biopsy detected more clinically significant prostate cancer lesions than existing detection methods. 

Prostate cancer is the most common cancer in men in the UK, with over 47,000 new cases diagnosed every year. In the UK, 1 in 8 men will get prostate cancer at some point in their lives. Prostate cancer mainly affects men over 50 and the risk increases with age. But the risk is higher for Black men (1 in 4) or men with a family history of prostate cancer, so they should speak to their GP from age 45.

Current methods of diagnosis and treatment are significantly flawed. The most common tests used are a PSA blood test, digital rectal examination, MRI scans, and biopsy.

Each carries significant problems, with MRI scans unable to always give a definitive answer. Ultrasound has similar issues, however combining the two forms of biopsy could potentially increase the detection rate of cancers

The research has already changed the detection and management of prostate cancer in the NHS Tayside area, and Professor Nabi says the results should inform future diagnosis guidelines.

“As with all cancers, the earlier that prostate cancer is detected then the more likely that a patient will have a more positive outcome,” he said. “Anything that speeds up diagnosis is therefore potentially lifesaving.

“What is particularly notable is that fact that the ultrasound/MRI fusion approach was not only more effective at identifying prostate cancer, but also more clinically significant lesions. One of the problems with current diagnostic methods is that they are sometimes unable to identify which cancers are benign and which need treatment.

“Our results suggest that if this approach was given to men routinely then prostate cancers would be detected earlier, lives would be saved, and unnecessary surgeries avoided.”

The research, published today in the journal Radiology, tested the diagnostic accuracy of combined US/MRI fusion biopsy with systematic biopsies.

In a randomised clinical trial, 413 participants with suspicious prostate lesions were randomised to either systematic random prostate biopsies alone or US/MRI fusion targeted biopsies. Clinically significant lesions were found in 51% of cases in the former group and 63% in the latter, demonstrating that combining US/MRI fusion was a more effective way of detecting prostate cancer.

The research was funded by Prostate Cancer UK, Movember and the Scottish Government’s Chief Scientist Office.

Dr Hayley Luxton, Senior Research Impact & Intelligence Manager at Prostate Cancer UK, said, “Getting a more accurate prostate cancer diagnosis means that a man can get the most specific and effective treatment tailored to him, as early as possible. 

“We’re excited that this research adds to existing evidence showing that targeted biopsies, guided by mpMRI imaging, improve the accuracy of prostate cancer diagnoses – which could lead to more men with the disease living better and longer lives. More work now needs to be done to ensure that these targeted biopsies pick up everything, and that’s why we continue to fund research.

“I’m proud that Prostate Cancer UK has supported Professor Nabi’s work for over a decade and am especially pleased that this vital study has taken place in Scotland, where currently 1 in 3 men with prostate cancer are diagnosed too late for a cure.”

Professor Dame Anna Dominiczak, Scottish Government Chief Scientist for Health, said, “Research is essential if innovative new approaches to the diagnosis of prostate cancer are to be developed. The Scottish Government is pleased to have worked with Prostate Cancer UK to co-fund this exciting work from Dundee aimed at developing new and improved diagnostic techniques.”