Originally published in The Australian (August 25, 2023)
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MRI success in detecting prostate cancer
EXCLUSIVE
By JOANNA PANAGOPOULOS and NATASHA ROBINSON
The Australian
New international research providing evidence of the effectiveness of MRIs in detecting prostate cancer could change the way the way the disease is screened for and help save the lives of more than 3500 Australians every year.
Australian experts say there is growing evidence to suggest MRI could help earlier detection of prostate cancer, the most commonly diagnosed invasive cancer in Australia.
Testing guidelines could also be broadened to routinely include MRI as a diagnostic tool prior to biopsy for at-risk men.
Based on current clinical guidelines, men without a family history of prostate cancer can request a prostate-specific antigen (PSA) blood test when they turn 50. If it returns an abnormal reading, a biopsy of tissue from the prostate gland is currently the only way to make a definitive diagnosis. The PSA test, however, is not foolproof and can lead to unreliable diagnosis.
MRI does not feature in the current guidelines.
A new study from University College London researchers, published in BMJ Oncology, found more than half of participants who had "serious prostate cancer" recorded a "low" PSA reading. The findings also suggest MRI could be more reliable than the PSA test in detecting serious cancers early.
"MRI is a particularly important risk mitigation strategy for men who develop prostate cancer with a low PSA, with evidence to suggest that low PSA prostate cancers can be lethal, Prostate Cancer Foundation of Australia CEO Anne Savage said.
Co-chair of a steering committee overseeing a review of Australia's clinical guidelines for PSA testing, Jeff Dunn, said MRI could also mitigate over-diagnosis and other risks. He said this "significant" new evidence would be reflected in the review of the guidelines.
"These findings add weight to the evidence that MRIs play an important role in preventing unnecessary biopsies," he said.
"Perhaps most importantly, there is emerging evidence that MRIs can play a key part in reducing mortality from the disease, which could help to save more than 3500 Australian men every year."
This included ensuring MRIs are accessible and affordable.
Leading Australian urologist and review cochair Peter Heathcote said this research could improve the ability to identify aggressive cancers earlier. Only about one-third of Australian men are diagnosed with prostate cancer at the earliest stages.
"This research suggests the use of MRI in screening men at a high risk of prostate cancer could help to identify significant lesions before the man's prostate specific antigen level has started to rise, which would allow us to treat prostate cancer at an earlier stage and improve overall survival," he said.
Unlike breast, bowel and cervical cancer, there is no national screening program for prostate cancer in Australia, but Ms Savage said community support for one was strong.
Even if the steering committee doesn't recommend a national screening program, she said there was "a strong likelihood that the steering committee will make comment on the need for a population-wide public awareness program".
"This could function in a similar way to existing programs for breast and bowel cancer screening, where men who are at risk of prostate cancer receive information and reminders to get tested," Ms Savage said.
