Title: MRI fusion biopsy in people with suspected prostate cancer [DAP64]
Funder: Department of Health and Social Care

Abstract: Prostate cancer is the most commonly diagnosed cancer in men in the UK. Around one in eight men get prostate cancer at some point in their life. Many procedures and tests can be used to investigate cases of suspected prostate cancer, including blood testing to measure levels of prostate specific antigen (PSA) (increased levels can indicate presence of cancer) and a digital rectal examination (a procedure in which a doctor inserts their finger into the person’s rectum so they can feel the prostate gland), to see whether the prostate gland is an abnormal shape or size. Other risk factors may be considered such as whether there is any family history of prostate cancer._x000D_ _x000D_ Information from the above tests and procedures can help inform a decision to have a Magnetic resonance imaging (MRI) (a technique that allows you to ‘see’ soft tissue (flesh) within the body) taken of the prostate to identify areas of concern that may be cancerous. These areas can be seen as a lesion on the MRI image. If a lesion is visible on the MRI, then a targeted prostate biopsy (using a biopsy needle to take of a small number of samples of the prostate tissue in the area where the lesion is visible) will be used to diagnose prostate cancer. Additional samples may also be taken from different regions of the prostate (systematic biopsy). If a lesion is not visible, but prostate cancer is still suspected, a systematic prostate biopsy can be recommended instead._x000D_ _x000D_ During the prostate biopsy procedure an ultrasound probe is placed in the rectum (back passage). The ultrasound probe uses sound waves to make an image of the prostate which is shown on a small screen. The ultrasound image helps the doctor move the biopsy needle to the correct location. Currently during a targeted prostate biopsy, the doctor will view the MRI image beforehand to help to guide the biopsy needle to areas of interest within the prostate during the procedure (cognitive fusion biopsy). An alternative approach is available that uses a computer software to combine the MRI and ultrasound image during the procedure, so the area of concern can be visualised in real time (MRI fusion biopsy)._x000D_ _x000D_ The aim of our research is to investigate whether the use of MRI fusion biopsy gives a more accurate diagnosis of prostate cancer compared to cognitive fusion biopsy, and whether the costs of MRI fusion biopsy, and any cancer treatments then given, produce benefits to patients that are considered an acceptable use of NHS resources (i.e., whether they are effective, safe and provide value for money). We will review all the relevant available research studies, using detailed systematic methods. We will examine how accurate MRI fusion biopsies are at detecting prostate cancer and if there are any harmful effects from the biopsy. We will also look at how much MRI fusion biopsy costs, per patient. To do this we will create a computer-software based economic model to estimate the costs and benefits to patients and the NHS of MRI fusion biopsy.

Lay abstract: The aim of the project is to assess the clinical and cost-effectiveness of MRI fusion biopsy systems in people with suspected localised and locally advanced prostate cancer.

Research activity codes: 6.3 MEDICAL DEVICES
Health categories: CANCER AND NEOPLASMS