English: Wrexham Maelor Hospital's urology unit is one of 11 units across England and Wales that took part in the prostate MRI imaging study PROMIS trial to discover improved ways of diagnosing prostate cancer. The results showed that 27 per cent of men who had a negative mpMRI did not need a biopsy at all, but, crucially, 93 per cent of aggressive cancers were detected by using the mpMRI scan to guide the biopsy, compared with just 48 per cent where only a transrectal ultrasound-guided prostate - TRUS - biopsy was carried out. When I raised this in the Chamber last March, I quoted the North Wales community health council welcoming the health Minister's commitment to expect health boards to revise their diagnostic pathways to incorporate these scans, if recommended by the National Institute for Health and Care Excellence, or NICE, in revised guidelines after April 2019, but also expressing concern that this would be too late and that patients in north Wales would continue to be left behind and that their discussions with urologists in north Wales suggested that we need to be developing the service then in preparation for NICE accreditation. Noting that NICE guidance already stated that mpMRI scans should be considered for men with a negative transrectal ultrasound 10 to 12-core biopsy to determine whether another biopsy is needed, I referred to constituents in north Wales who met this criteria, but who then had to pay around £900 to fund these scans because they were not provided or funded by the health board in north Wales. Three of my constituents then wrote to the Minister confirming that they had had to pay and stating that they had watched this and seen him, quote, 'smirk and laugh at them'. After raising this again with the health Minister last April, they told me that his statement to the Senedd that service provision in the Welsh NHS is in line with NICE guidelines is patently not true, as you evidenced in your question. Another patient told me that last March's announcement by NHS England that it was launching a one-stop service using MRI techniques to revolutionise prostate cancer treatment and slash the time taken for a diagnosis there was a game changer and patients across Wales should not be left behind. Last December, NICE issued new draft guidance recommending pre-biopsy mpMRI for suspected prostate cancer, with final guidance expected next month. In January, the health Minister wrote to Members stating that he had asked all health boards to work with the Welsh urology board to ensure that they have full implementation plans within one month of this. In the same letter, he stated that health boards had confirmed that, at present, they deliver care in line with current NICE guidance. North Wales patients subsequently reiterated that care was not delivered in line with current NICE guidance in their cases. The north Wales community health council stated that the health board have consistently declined to produce proof that they did any scans for men with rising prostate specific antigen following a negative biopsy, and that they are co-ordinating refunds to all of their clients who did not receive scans in line with the 2014 guidance. They also state that their correspondence with the health Minister gives them no comfort that he will intervene if they make the same decision on the pre-biopsy mpMRI guidance. This petition's sponsor, Stuart Davies, states that interim arrangements should be put in place now so that men do not put their lives at risk; that although patients pay approximately £900, the cost to the NHS at Wrexham's Spire hospital is only £365; and that men contacting the campaign say that they are either waiting for it to become free or are taking out loans to pay for their scan. Last December, I attended a meeting with Mr Davies, the health board and community health council, at which the health board apologised and offered to refund the money the men had paid for scans. However, only this week, a constituent received a letter from the health board stating that, 'although current clinical advice suggests that the use of full diagnostic mpMRI may be beneficialthis has not yet been supported by NICE'. Noting, however, that NICE has now backed mpMRI scans as a cost-effective first-line investigation, Tenovus Cancer Care have called on the Welsh Government to ensure that mpMRI is available across Wales, stating that it is not available at Betsi Cadwaladr, Hywel Dda or Swansea bay, and not available at PROMIS standards in Cardiff and Vale. As Prostate Cancer UK states, mpMRI revolutionises prostate cancer diagnosis, so let's listen to the experts with lived experience. These men have been telling the truth from the very beginning.
Welsh: Mae uned wroleg Ysbyty Maelor Wrecsam yn un o 11 o unedau ledled Cymru a Lloegr a gymerodd ran yn nhreial astudiaeth ddelweddu'r prostad MRI PROMIS i ganfod ffyrdd gwell o wneud diagnosis o ganser y prostad. Dangosodd y canlyniadau nad oedd angen i 27 y cant o'r dynion a gafodd mpMRI negyddol gael biopsi o gwbl, ond yn hollbwysig, cafodd 93 y cant o ganserau ymledol eu canfod drwy ddefnyddio'r sgan mpMRI i gyfeirio'r biopsi, o'i gymharu â dim ond 48 y cant lle gwnaed biopsi prostad uwchsain trawsrefrol - TRUS - yn unig. Pan godais hyn yn y Siambr fis Mawrth diwethaf, dyfynnais gyngor iechyd cymuned gogledd Cymru a groesawodd ymrwymiad y Gweinidog iechyd i ddisgwyl i fyrddau iechyd adolygu eu llwybrau diagnostig i ymgorffori'r sganiau hyn, os câi hynny ei argymell gan y Sefydliad Cenedlaethol ar gyfer Rhagoriaeth mewn Iechyd a Gofal, neu NICE, mewn canllawiau diwygiedig ar ôl Ebrill 2019, ond gan fynegi pryder hefyd y byddai hyn yn rhy hwyr ac y byddai cleifion yng ngogledd Cymru yn parhau i gael eu gadael ar ôl a bod eu trafodaethau gydag wrolegwyr yng ngogledd Cymru yn awgrymu bod angen inni ddatblygu'r gwasanaeth er mwyn paratoi ar gyfer achrediad NICE. Gan nodi bod canllawiau NICE eisoes yn datgan y dylid ystyried sganiau mpMRI ar gyfer dynion sydd wedi cael biopsi uwchsain trawsrefrol 10 i 12 craidd negyddol i benderfynu a oes angen biopsi arall, cyfeiriais at etholwyr yng ngogledd Cymru a oedd yn bodloni'r meini prawf hyn, ond y bu'n rhaid iddynt dalu tua £900 wedyn i dalu am y sganiau hyn oherwydd nad oeddent yn cael eu darparu neu eu hariannu gan y bwrdd iechyd yng ngogledd Cymru. Ysgrifennodd tri o fy etholwyr at y Gweinidog wedyn i gadarnhau eu bod wedi gorfod talu ac yn datgan eu bod wedi gwylio hyn ac wedi ei weld, rwy'n dyfynnu, 'yn cilwenu a chwerthin ar eu pennau'. Ar ôl codi hyn eto gyda'r Gweinidog iechyd fis Ebrill diwethaf, dywedasant wrthyf ei bod yn amlwg nad yw ei ddatganiad i'r Senedd fod y ddarpariaeth yn GIG Cymru yn cyd-fynd â chanllawiau NICE yn wir, fel y dangosodd eich cwestiwn. Dywedodd claf arall wrthyf fod y cyhoeddiad fis Mawrth diwethaf gan GIG Lloegr ei fod yn lansio gwasanaeth un stop gan ddefnyddio technegau MRI i chwyldroi triniaeth canser y prostad a thorri'r amser a gymerai i wneud diagnosis yno yn newid sylfaenol ac na ddylai cleifion ledled Cymru gael eu gadael ar ôl. Fis Rhagfyr diwethaf, cyhoeddodd NICE ganllawiau drafft newydd yn argymell mpMRI cyn-biopsi lle ceir amheuaeth o ganser y prostad, gyda'r canllawiau terfynol i ddod y mis nesaf. Ym mis Ionawr, ysgrifennodd y Gweinidog iechyd at yr Aelodau'n nodi ei fod wedi gofyn i bob bwrdd iechyd weithio gyda bwrdd wroleg Cymru er mwyn sicrhau bod ganddynt gynlluniau gweithredu llawn o fewn un mis i hynny. Yn yr un llythyr, dywedodd fod byrddau iechyd wedi cadarnhau eu bod, ar hyn o bryd, yn darparu gofal yn unol â chanllawiau NICE presennol. Ailadroddodd cleifion yng ngogledd Cymru wedyn nad oedd gofal yn cael ei ddarparu yn unol â chanllawiau NICE cyfredol yn eu hachos hwy. Dywedodd cyngor iechyd cymuned gogledd Cymru fod y bwrdd iechyd wedi gwrthod cynhyrchu prawf yn gyson eu bod yn cyflawni unrhyw sganiau ar gyfer dynion gyda lefel gynyddol o antigen penodol y prostad yn dilyn biopsi negyddol, a'u bod yn cyd-drefnu ad-daliadau i'w holl gleientiaid na chafodd sganiau yn unol â chanllawiau 2014. Maent hefyd yn dweud nad yw eu gohebiaeth â'r Gweinidog iechyd yn rhoi unrhyw gysur iddynt y bydd yn ymyrryd os byddant yn gwneud yr un penderfyniad ar y canllawiau mpMRI cyn-biopsi. Mae noddwr y ddeiseb hon, Stuart Davies, yn datgan y dylid rhoi trefniadau dros dro ar waith yn awr fel nad yw dynion yn peryglu eu bywydau; mai'r gost i'r GIG yn ysbyty Spire Wrecsam yw £365 yn unig er y bydd cleifion yn talu tua £900; a bod dynion sy'n cysylltu â'r ymgyrch yn dweud eu bod naill ai'n aros iddo ddod am ddim neu'n cael benthyciadau i dalu am eu sgan. Fis Rhagfyr diwethaf, bûm mewn cyfarfod gyda Mr Davies, y bwrdd iechyd a'r cyngor iechyd cymuned, lle ymddiheurodd y bwrdd iechyd a chynnig ad-dalu'r arian a dalodd y dynion am eu sganiau. Fodd bynnag, yr wythnos hon, cafodd etholwr lythyr gan y bwrdd iechyd yn dweud, er bod cyngor clinigol presennol yn awgrymu y gall y defnydd o mpMRI diagnostig llawn fod yn fuddiolnid yw NICE wedi cefnogi hyn eto. Gan nodi, fodd bynnag, fod NICE bellach wedi cefnogi sganiau mpMRI fel dull archwilio llinell gyntaf costeffeithiol, mae Tenovus Cancer Care wedi galw ar Lywodraeth Cymru i sicrhau bod mpMRI ar gael ledled Cymru, gan ddweud nad yw ar gael yn Betsi Cadwaladr, Hywel Dda na bae Abertawe, ac nid yw ar gael ar lefel safonau PROMIS yng Nghaerdydd a'r Fro. Fel y dywed Prostate Cancer UK, mae mpMRI yn chwyldroi diagnosis canser y prostad, felly gadewch i ni wrando ar yr arbenigwyr sydd â phrofiad byw ohono. Mae'r dynion hyn wedi bod yn dweud y gwir o'r cychwyn cyntaf.