PROVIDING a welcome alternative to expensive and time-consuming MRI scans, research from some of London’s leading establishments has found ultrasound can accurately diagnose prostate cancer. Hashim Ahmed, Imperial College London, UK, highlighted the profound implications of this discovery: “Prostate cancer is the most commonly diagnosed cancer in the UK. One in six men will be diagnosed with the disease in their lifetimes and that figure is expected to rise.” This research paves the way for use of an ultrasound scan in community health screening programmes, and its provision in low- or middle-income countries, which do not have easy access to high-quality MRI facilities.
The ultrasound scans missed only 4.3% more clinically important prostate cancer cases, which should be treated rather than monitored, compared with the multi-parametric MRI (mpMRI) scans that are currently implemented. This research, a collaboration between Imperial College London, University College London, and Imperial College Healthcare NHS Trust, examined the use of multi-parametric ultrasound (mpUSS), which uses a rectal transducer probe to take images of the prostate. In this new method, the doctor conducting the examination also considers the stiffness of tissue and blood supply via elastography, doppler, and contrast-enhancement with microbubbles.
This trial, labelled Cancer Diagnosis by Multiparametric Ultrasound of the Prostate (CADMUS), was conducted across seven hospitals in the UK and involved 370 men at risk of prostate cancer, who were identified following prostate-specific antigen tests and abnormal digital rectal examination. Men were given both mpUSS and mpMRI scans, followed by biopsies for 257 of the patients with positive test results. Cancer was detected in 133 men, 83 of whom were diagnosed with clinically significant cancer. mpUSS detected 66 cases, compared with 77 in mpMRI. The researchers believe this provides sufficient evidence to warrant use of mpUSS as a first test for those at risk of prostate cancer. Both tests missed clinically important cancers detected by the other, suggesting that use of both is preferable to each test alone. Alistair Grey, University College London, stated: “Our results provide an accurate test for prostate cancer in patients who were previously without one using a scan that’s cheap and easy to conduct.”
Although mpMRI remains the gold standard in prostate cancer detection, this method is more time-consuming and costs 350–450 GBP per test. This research will prove essential in the near future, as prostate cancer cases continue to rise, by delivering an alternative and more inclusive screening method for patients who are unable to have MRI scans, such as those with joint replacements or claustrophobia.