Prostate cancer could be diagnosed faster with ‘game changing' ultrasound scan
Currently patients must undergo both an MRI scan and biopsy, in which a sample is removed and tested for cancer.
The MRI scan is mapped onto an ultrasound image for the biopsy, which can often be on a different day, allowing doctors to pinpoint the position of the cancer and get a sample.
But scientists have found that a new, high-resolution micro-ultrasound – a clearer, more detailed version of the technology used to image a baby in a womb – could speed up the process with just as accurate results.
The researchers, led by the University of Toronto, said using micro-ultrasound (microUS) was quicker, cheaper and safer than MRI scans, and so could speed up diagnosis, reduce hospital visits, and free up MRI machines for other people.
The Optimum trial, which is being presented at the European Association of Urology (EAU) Congress in Madrid on Sunday, and published in the journal, JAMA, involved 677 men who underwent biopsies at 19 hospitals across Canada, the US and Europe.
Patients were randomly assigned to one of three groups: half underwent MRI-guided biopsy, a third received microUS-guided biopsy followed by MRI-guided biopsy and the remainder received microUS-guided biopsy alone.
The study revealed there were very similar rates of prostate cancer detected across all three groups, with biopsies taken using the micro-ultrasound scan just as effective as MRI.
About 100,000 men in the UK undergo a prostate biopsy every year and more than 50,000 men are diagnosed with prostate cancer.
A lack of accurate screening tests means many men with high protein-specific antigen (PSA) scores are sent for such scans and biopsies to confirm or rule out cancer.
The MicroUS uses a higher frequency than standard ultrasound and provides images that have three times greater resolution, and can therefore capture similar detail to MRI scans.
Prof Laurence Klotz, lead researcher and professor of surgery at the University of Toronto, said the trial's results could have a similar impact to that of MRI when it was introduced.
'When MRI first emerged and you could image prostate cancer accurately for the first time to do targeted biopsies, that was a game changer,' he said. 'But MRI isn't perfect. It's expensive. It can be challenging to get access to it quickly. It requires a lot of experience to interpret properly.'
He said MRI also used 'gadolinium which has some toxicity' and that certain patients – such as those with hip replacements or pacemakers – could not have an MRI scan.
'But we now know that microUS can give as good a diagnostic accuracy as MRI and that is also game changing,' Prof Klotz added.
'It means you can offer a one-stop shop, where patients are scanned, then biopsied immediately if required. There's no toxicity. There are no exclusions. It's much cheaper and more accessible. And it frees up MRIs for hips and knees and all the other things they're needed for.'
Commenting on the findings, Prof Jochen Walz, a urological imaging expert from the Institute Paoli-Calmettes, a cancer centre in Marseille, said it added 'a very important tool to the diagnosis of prostate cancer'.
He said it was also 'safer' because it avoided the potential for 'errors that can creep in' when MRI images are manually transferred to ultrasound.
'It does require training to spot the patterns and interpret micro-ultrasound images correctly. But once that's been mastered, then it could enable prostate cancer diagnosis and biopsy to happen at the same appointment,' Prof Walz said.
'The ease and cost of micro-ultrasound means it could be an important tool for screening programmes as well, but further research would be needed to understand its potential role in that setting.'
The trial was sponsored by Canadian company Exact Imaging, which has developed the microUS technology.
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