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Petition number: P-05-849 Petition title: All men in Wales should have access through the NHS to the best possible diagnostic tests for prostate cancer Text of petition: We, the undersigned call on the National Assembly for Wales to urge the Welsh Government to act now and make high-quality, multi-parametric MRI (mpMRI) before biopsy scans available to all eligible men across Wales who have a suspicion of prostate cancer.

Background

Prostate cancer is the most common cancer in men in Wales, accounting for just over a quarter of men’s cancer cases. In Wales, 12,592 cases of prostate cancer were diagnosed between 2011 and 2015.

The most commonly used tests for diagnosing prostate cancer include a blood test (prostate-specific antigen (PSA) test), a physical examination of the prostate (known as a digital rectal examination), and a transrectal ultrasound-guided (TRUS) biopsy. Biopsies can cause discomfort, and potential side effects 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.

Research published in February 2017 (known as PROMIS - Prostate MR Imaging Study) found that using a multi-parametric magnetic resonance imaging (MP-MRI) scan as a triage test before biopsy could reduce the number of unnecessary biopsies and could improve the detection of clinically significant cancer. (MP-MRI scans can create more detailed pictures of the prostate than standard MRI scans).

The charity Prostate Cancer UK are campaigning on this issue, having carried out some work to establish that access to MP-MRIs is not equitable across the UK. The charity states:

Some areas in Wales do not offer access to mpMRI before biopsy at all. This is in large part due to a lack of resources to achieve widespread adoption. However, our activities have encouraged the Welsh Urology Board, with support from the Welsh Programme of Care Board, to make the adoption of mpMRI before biopsy a top priority.

Two centres in Wales are already leading the way, with Cwm Taf providing a one-stop shop service – like the RAPID pathway being piloted in England - and Aneurin Bevan, transforming its diagnostic pathway so that every man with suspected of having prostate cancer gets an mpMRI scan before a biopsy as standard practice.

We are working in collaboration with the Welsh Planned Care Programme team and Welsh Urology Board to support Welsh Health Boards in the adoption of high-quality, pre-biopsy mpMRI.

A key development to be aware of is that the National Institute for Health and Care Excellence (NICE) is currently updating its guidance on the diagnosis and management of prostate cancer, and will be considering the use of MP-MRI pre-biopsy in light of the PROMIS trial’s findings.    

Welsh Government response to the petition

In his response to the Committee, the Cabinet Secretary set out his expectation that Health Boards deliver consistent, high quality care in line with relevant clinical guidance, such as that issued by NICE.

He highlights that NICE does not currently recommend pre-biopsy mpMRI, but that it is reviewing its guidance on the diagnosis and management of prostate cancer. This is expected to be published in April 2019.

He stated:

If NICE recommends pre-biopsy mpMRI then I will expect all Health Boards to amend their pathways accordingly. However, what the Welsh Government cannot do is make a decision on what is the most clinically appropriate pathway to investigate suspected prostate cancer. This must be the responsibility of Health Boards and clinical leaders, based on the evidence available. I expect there to be greater consistency in service provision after the NICE guidelines have been updated.