English: Diolch, Dirprwy Lywydd. This evening's debate will focus on a petition submitted by Stuart Davies, who lives in the constituency of Clwyd South. It calls for all men in Wales to have access through the NHS to the best possible diagnostic tests for prostate cancer. The petition received 6,345 signatures and the Petitions Committee is grateful for the opportunity to bring this petition to the Assembly today, under the process whereby the committee considers the merits of holding a debate on a petition that receives more than 5,000 signatures. It is worth noting here that prostate cancer is the most common cancer for men in Wales, with more than 2,500 men diagnosed in Wales every year. Mr. Davies's petition calls for the latest prostate screening technology to be available to all men where there is a suspicion of prostate cancer. Specifically, the technology is the multiparametric MRI scan, or mpMRI. This combines up to three different types of scan in order to provide a clearer picture of the prostate gland. It is different to standard MRI scans, which are rarely clear enough to facilitate a confident diagnosis of prostate cancer at an early stage. Up to now, men have typically needed to undergo a biopsy to diagnose prostate cancer. These are invasive and painful, and the potential side effects can include bleeding and infection. They may also miss up to one in five cancers of the prostate, because the precise location of the cancer is unknown when the biopsy is carried out. Alongside biopsy, the most commonly used tests for diagnosing prostate cancer include a blood test and physical examination of the prostate. A study published in February 2017, known as PROMIS, found that using an mpMRI scan could reduce the number of unnecessary biopsies and improve the detection of clinically significant cancer. The petition is seeking access to mpMRI scans for all men in Wales as a priority, in order to improve diagnosis and reduce the number of men having to undergo biopsies. Prostate Cancer UK is also campaigning for increased access to mpMRI across the United Kingdom. The National Institute for Health and Care Excellence, NICE, is currently in process of revising their guidance in relation to the diagnosis and management of prostate cancer. This review includes an assessment of the latest evidence, including the PROMIS study. In December, NICE published new draft guidance for consultation. It includes a recommendation for mpMRI scans to be used as a first line investigation for people with suspected prostate cancer, as called for in the petition. The guideline proposes that patients should still undergo a blood test initially, with an mpMRI used to better detect suspected clinically significant prostate cancer. NICE states that the scan can help clinicians understand the location of the cancer and target the biopsy directly, reducing the time taken to accurately identify the cancer and the need for multiple biopsies. Therefore, it is expected that increased use of mpMRI will prove cost effective by reducing the number of biopsies performed and the need for further treatment, because cancers are more likely to be detected and identified earlier. The final guideline is expected to be published at the end of April. The petitioner and Prostate Cancer UK both argue that the current situation is inequitable. A number of areas already offer access to mpMRI scans. In Wales, Cwm Taf and Aneurin Bevan health boards routinely provide mpMRI scans for suspected prostate cancer. Another, Cardiff and Vale health board, offers pre-biopsy MRI scans, though not the full specification targeted by the campaign. This leaves patients in west, north and parts of south Wales currently unable to access the tests, whilst patients in Powys are generally referred elsewhere. In areas where the scans are not available, the petitioner states that he and other men with suspected prostate cancer have faced paying £900 to have one done privately. He has pointed out that a trial was previously carried out in Wrexham Maelor Hospital, but the scans are not currently available on the NHS in north Wales. Across the UK, Prostate Cancer UK has found that only half of men with suspected prostate cancer are offered the highest standards of mpMRI scans before a biopsy. The new NICE guideline, if confirmed, should change this. However, the Petitions Committee has learned that there are likely to be a number of challenges to implementing this quickly in Wales. The most obvious challenge is access to the scanners themselves. High-quality mpMRI scans rely on MRI scanners being configured in a specific way and, generally, being less than 10 years old. Existing demand on the scanners is another potential challenge due to high demand for their use existing across a wide range of conditions. A further potential barrier is the number of radiologists, especially those with the required training to accurately report the results of scans and to use them to conclusively rule out the presence of cancer in some patients. These are challenges that health boards and the Welsh Government are likely to need to face when the final NICE guideline is published. The Minister has stated that he expects all health boards to consider new guidance and amend their pathways of care accordingly. He has also informed the committee that he expects there to be greater consistency in service provision after the NICE guideline has been updated. We understand that several workshops have already taken place, led by the Wales urology board, to assess the changes that will be required and to help health boards to plan for them. The Minister has also stressed that health boards do not need to wait for the final guidance to determine what local changes are needed. The petitioner stresses that time is of the essence and that any delay in this process could cause issues in diagnosing individual patients. He is calling on the Welsh Government to ensure that the new standards are implemented rapidly and for mpMRI scans to be available across Wales as early as possible. In the meantime the petitioner has argued that the Welsh Government should fund interim arrangements, under which the NHS would pay for patients to access private scans in order to ensure that all patients who would benefit from mpMRI technology can do so. Dirprwy Lywydd, I am sure that other Members and the Minister will wish to comment on these issues further through the remainder of the debate this afternoon. Diolch yn fawr.
Welsh: Diolch, Ddirprwy Lywydd. Bydd y ddadl heno yn canolbwyntio ar ddeiseb a gyflwynwyd gan Stuart Davies, sy'n byw yn etholaeth De Clwyd. Mae'n galw am sicrhau bod pob dyn yng Nghymru yn cael mynediad drwy'r GIG at y profion diagnostig gorau posibl ar gyfer canser y prostad. Ceir 6,345 o lofnodion ar y ddeiseb, ac mae'r Pwyllgor Deisebau yn ddiolchgar am y cyfle i gyflwyno'r ddeiseb hon i'r Cynulliad heddiw, o dan y broses lle mae'r pwyllgor yn ystyried rhinweddau cynnal dadl ar ddeiseb sy'n denu mwy na 5,000 o lofnodion. Mae'n werth nodi yma mai canser y prostad yw'r canser mwyaf cyffredin ymhlith dynion yng Nghymru, gyda mwy na 2,500 o ddynion yn cael diagnosis ohono yng Nghymru bob blwyddyn. Mae deiseb Mr Davies yn galw am sicrhau bod y dechnoleg ddiweddaraf ar gyfer sgrinio'r prostad ar gael i bob dyn lle ceir amheuaeth o ganser y prostad. Yn benodol, sgan MRI amlbaramedr yw'r dechnoleg honno, neu mpMRI. Mae'n cyfuno hyd at dri math o sgan er mwyn darparu darlun cliriach o'r chwarren brostad. Mae'n wahanol i sgan MRI arferol, sy'n aml heb fod yn ddigon clir i hwyluso diagnosis hyderus o ganser y prostad ar gam cynnar. Hyd yma, mae dynion fel arfer wedi gorfod cael biopsi er mwyn gallu gwneud diagnosis o ganser y prostad. Mae'r driniaeth yn ymyrrol ac yn boenus, a gall y sgil-effeithiau posibl gynnwys haint a gwaedu. Gall hefyd fethu canfod hyd at un o bob pump canser y prostad, oherwydd nad yw union leoliad y canser yn hysbys pan gyflawnir y biopsi. Ochr yn ochr â biopsi, mae'r profion mwyaf cyffredin a ddefnyddir ar gyfer gwneud diagnosis o ganser y prostad yn cynnwys prawf gwaed ac archwiliad corfforol o'r prostad. Canfu astudiaeth a gyhoeddwyd yn Chwefror 2017, astudiaeth o'r enw PROMIS, y gallai defnyddio sgan mpMRI leihau nifer y triniaethau biopsi diangen a gwella'r modd o ganfod canser sy'n glinigol arwyddocaol. Mae'r ddeiseb hon yn galw am fynediad at sganiau mpMRI i bob dyn yng Nghymru fel mater o flaenoriaeth, er mwyn gwella diagnosis a lleihau nifer y dynion sy'n gorfod cael biopsi. Mae Prostate Cancer UK hefyd yn ymgyrchu dros gynyddu mynediad at mpMRI ar draws y Deyrnas Unedig. Ar hyn o bryd, mae'r Sefydliad Cenedlaethol dros Ragoriaeth mewn Iechyd a Gofal, NICE, wrthi'n adolygu eu canllawiau mewn perthynas â diagnosis o ganser y prostad a'r dull o'i drin. Mae'r adolygiad hwn yn cynnwys asesiad o'r dystiolaeth ddiweddaraf, gan gynnwys yr astudiaeth PROMIS. Ym mis Rhagfyr, cyhoeddodd NICE ganllawiau drafft newydd ar gyfer ymgynghori. Mae'n cynnwys argymhelliad y dylid defnyddio sganiau mpMRI fel dull cam cyntaf o archwilio ar gyfer pobl yr amheuir bod canser y prostad arnynt, fel y mae'r ddeiseb yn galw amdano. Mae'r canllaw'n argymell y dylai cleifion ddal i gael prawf gwaed i gychwyn, a defnyddio mpMRI fel dull gwell o ganfod canser sy'n glinigol arwyddocaol mewn dynion yr amheuir bod canser y prostad arnynt. Dywed NICE y gall y sgan helpu clinigwyr i ddeall lleoliad y canser a thargedu'r biopsi'n uniongyrchol, gan leihau'r amser y mae'n gymryd i adnabod y canser yn fanwl a'r angen am biopsïau lluosog. Felly, disgwylir y bydd mwy o ddefnydd o mpMRI yn profi'n gosteffeithiol drwy ei fod yn lleihau nifer y triniaethau biopsi a gyflawnir a'r angen am ragor o driniaeth, gan fod canserau'n fwy tebygol o gael eu canfod a'u hadnabod yn gynharach. Disgwylir i'r canllaw terfynol gael ei gyhoeddi ddiwedd mis Ebrill. Mae'r deisebydd a Prostate Cancer UK yn dadlau bod y sefyllfa bresennol yn annheg. Mae nifer o ardaloedd eisoes yn cynnig mynediad at sganiau mpMRI. Yng Nghymru, mae byrddau iechyd Cwm Taf ac Aneurin Bevan yn darparu sganiau mpMRI fel mater o drefn ar gyfer dynion yr amheuir bod canser y prostad arnynt. Mae un arall, bwrdd iechyd Caerdydd a'r Fro, yn cynnig sganiau MRI cyn-biopsi, ond nid y ddarpariaeth lawn a dargedir gan yr ymgyrch. Mae hyn yn golygu na all cleifion yn y gorllewin, y gogledd a rhannau o dde Cymru gael mynediad at y profion ar hyn o bryd, tra bo cleifion ym Mhowys at ei gilydd yn cael eu cyfeirio i fannau eraill. Mewn ardaloedd lle nad yw'r sganiau ar gael, dywed y deisebydd ei fod ef a dynion eraill y ceid amheuaeth fod canser y prostad arnynt wedi wynebu gorfod talu £900 i gael eu sganio'n breifat. Nododd fod treial wedi'i gyflawni'n flaenorol yn Ysbyty Maelor Wrecsam, ond nid yw'r sganiau ar gael ar hyn o bryd o dan y GIG yng ngogledd Cymru. Ledled y DU, mae Prostate Cancer UK wedi canfod nad yw hanner y dynion yr amheuir bod canser y prostad arnynt yn cael cynnig sganiau mpMRI o'r safon uchaf cyn cael biopsi. Os caiff ei gadarnhau, dylai'r canllaw NICE newydd newid hyn. Fodd bynnag, mae'r Pwyllgor Deisebau wedi dysgu ei bod yn debygol y bydd nifer o heriau i weithredu hyn yn gyflym yng Nghymru. Yr her fwyaf amlwg yw mynediad at y sganwyr eu hunain. Mae sganiau mpMRI o ansawdd uchel yn dibynnu ar fod sganwyr MRI wedi'u cyflunio mewn modd penodol ac yn gyffredinol, mae gofyn iddynt fod yn llai na 10 oed. Mae'r galw presennol am sganwyr yn her arall bosibl oherwydd y galw uchel am eu defnydd ar draws ystod eang o gyflyrau. Rhwystr pellach o bosibl yw nifer y radiolegwyr, yn enwedig radiolegwyr sydd wedi cael yr hyfforddiant angenrheidiol i allu cofnodi canlyniadau sganiau'n gywir a'u defnyddio i allu dweud yn bendant nad oes canser yn bresennol mewn rhai cleifion. Mae'r rhain yn heriau y mae byrddau iechyd a Llywodraeth Cymru yn debygol o fod angen eu hwynebu pan gyhoeddir y canllawiau terfynol gan NICE. Mae'r Gweinidog wedi dweud ei fod yn disgwyl i bob bwrdd iechyd ystyried canllawiau newydd a newid eu llwybrau gofal yn unol â hynny. Mae hefyd wedi dweud wrth y pwyllgor ei fod yn disgwyl gweld mwy o gysondeb o ran y ddarpariaeth o wasanaethau ar ôl i'r canllaw NICE gael ei ddiweddaru. Deallwn fod sawl gweithdy eisoes wedi'u cynnal, dan arweiniad bwrdd wroleg Cymru, i asesu'r newidiadau y bydd eu hangen ac i helpu byrddau iechyd i gynllunio ar eu cyfer. Pwysleisiodd y Gweinidog hefyd nad oes angen i fyrddau iechyd aros am y canllawiau terfynol i benderfynu pa newidiadau sydd eu hangen yn lleol. Mae'r deisebydd yn pwysleisio fod amser yn brin ac y gallai unrhyw oedi yn y broses hon achosi problemau o ran sicrhau diagnosis i gleifion unigol. Mae'n galw ar Lywodraeth Cymru i sicrhau bod y safonau newydd yn cael eu gweithredu'n gyflym ac i sganiau mpMRI fod ar gael ledled Cymru cyn gynted â phosibl. Yn y cyfamser mae'r deisebydd wedi dadlau y dylai Llywodraeth Cymru ariannu trefniadau dros dro er mwyn sicrhau y byddai'r GIG yn talu i gleifion allu cael mynediad at sganiau preifat er mwyn gwneud yn siŵr fod pob claf a allai elwa o dechnoleg mpMRI yn cael gwneud hynny. Ddirprwy Lywydd, rwy'n siŵr y bydd y Gweinidog ac Aelodau eraill yn dymuno gwneud sylwadau pellach ar y materion hyn drwy weddill y ddadl y prynhawn yma. Diolch yn fawr.