Urology department MRI use for Prostate Cancer Diagnosis

The request was successful.

Dear Croydon Health Services NHS Trust,

Prostate Cancer UK undertook a Freedom of Information Act (FOI) request of all Trusts, Health Boards and Health and Social Care Trusts in 2016, and again in 2018, with the aim of achieving a state of the nation overview of the use of mpMRI before biopsy.

We gained an in-depth understanding of the current status of mpMRI before prostate biopsy across the UK. We have used the data to make the case to National Commissioners for implementation support. It has also guided our funding and development of resources that respond to some of the challenges and barriers to implementation that centres told us they faced.

This third and final round of questions is our means of understanding what progress has been made and to identify where we can target our resources and National Commissioners’ support to have maximum impact.

We really appreciate your help with this. Please pass the below on to your urology department for them to complete. If this is not possible we would really appreciate your help to provide as much information as you can.

Yours faithfully,

Lizzie Ellis

1. Do you routinely conduct prostate MRI (bpMRI/mpMRI) scans before first prostate biopsy as part of the initial diagnostic process? (please tick all that apply):

a. Yes, using T2-weighted, diffusion-weighted (multi-b ADC and high/long b) and dynamic contrast enhanced (DCE) sequences
b. Yes, using T2-weighted, diffusion-weighted (multi-b ADC and high/long b) sequences but not DCE
c. No but we refer to another provider (please provide details)
d. No (please provide details)

2. If yes, to 1a: What percentage of men with suspected prostate cancer receive mpMRI before biopsy as part of the initial diagnostic process?

3. If yes, to 1b: What percentage of men with suspected prostate cancer receive bpMRI before biopsy as part of the initial diagnostic process?

4. What are your eligibility criteria/exclusion criteria for prostate MRI? (please tick all that apply):
a. Age (please provide details)
b. Symptoms (please provide details)
c. Life expectancy (please provide details)
d. Contra-indications (please provide details)
e. Other (please provide details)

5. Are you using results from the prostate MRI before biopsy to rule some men out of biopsy as part of the initial diagnostic process? (yes/no)

6. Do you biopsy all PI-RADS or LIKERT 3 scores?
a. Yes
b. No
c. Dependent on patient histology

7. What threshold do you mostly use for ruling men out of biopsy?
a. PI-RADs 3 and above
b. LIKERT 3 and above
c. PI-RADs 4 and above
d. LIKERT 4 and above
e. Varies depending on age (Please provide detail)
f. Varies depending on other factors (Please provide detail)

8. What percentage of men do you estimate are ruled out of biopsy?

9. Have there been any changes to your prostate MRI capacity in the last year? (please choose all that apply):
a. An additional or new MRI scanner
b. Increased MRI scanner slots for prostate
c. Agreement to use Dynamic Contrast Enhancement
d. No longer using Dynamic Contrast Enhancement
e. A scanner/magnet upgrade
f. other (free text)

10. Has the number of radiologists at your trust/health board who report prostate MRI scans changed in the last year?
a. Increased
b. Decreased
c. Stayed the same

11. How many radiologists at your trust/health board report at least 250 prostate MRI scans per year?

12. Which of the following processes do you follow to manage men ruled out of an immediate biopsy, but with a raised PSA?
a. NICE Guidelines: prostate cancer diagnosis and management (NG131)
b. A local protocol (please provide details)
c. Other (please provide details)

foi (CROYDON HEALTH SERVICES NHS TRUST), Croydon Health Services NHS Trust

FOI 1612: Our reference New Freedom of Information Request –
Acknowledgement
Thank you for your FOI request which is now being considered.  Your
reference number is: FOI 1612, and should be quoted in all your future
correspondence relating to this request.
It is anticipated that a response will be communicated to you within 20
working days in compliance with the Freedom of Information Act 2000.
Kind regards
FOI Team
Croydon Health Services NHS Trust
Email: [email address]

________________________________________
From: Lizzie Ellis <[FOI #597686 email]>
Sent: 16 August 2019 15:05
To: foi (CROYDON HEALTH SERVICES NHS TRUST)
Subject: Freedom of Information request - Urology department MRI use for
Prostate Cancer Diagnosis

Dear Croydon Health Services NHS Trust,

Prostate Cancer UK undertook a Freedom of Information Act (FOI) request of
all Trusts, Health Boards and Health and Social Care Trusts in 2016, and
again in 2018, with the aim of achieving a state of the nation overview of
the use of mpMRI before biopsy.

We gained an in-depth understanding of the current status of mpMRI before
prostate biopsy across the UK. We have used the data to make the case to
National Commissioners for implementation support. It has also guided our
funding and development of resources that respond to some of the
challenges and barriers to implementation that centres told us they faced.

This third and final round of questions is our means of understanding what
progress has been made and to identify where we can target our resources
and National Commissioners’ support to have maximum impact.

We really appreciate your help with this. Please pass the below on to your
urology department for them to complete. If this is not possible we would
really appreciate your help to provide as much information as you can.

Yours faithfully,

Lizzie Ellis

1.      Do you routinely conduct prostate MRI (bpMRI/mpMRI) scans before
first prostate biopsy as part of the initial diagnostic process? (please
tick all that apply):

a.      Yes, using T2-weighted, diffusion-weighted (multi-b ADC and
high/long b) and dynamic contrast enhanced (DCE) sequences
b.      Yes, using T2-weighted, diffusion-weighted (multi-b ADC and
high/long b) sequences but not DCE
c.      No but we refer to another provider (please provide details)
d.      No (please provide details)

2.      If yes, to 1a: What percentage of men with suspected prostate
cancer receive mpMRI before biopsy as part of the initial diagnostic
process?

3.      If yes, to 1b: What percentage of men with suspected prostate
cancer receive bpMRI before biopsy as part of the initial diagnostic
process?

4.      What are your eligibility criteria/exclusion criteria for prostate
MRI? (please tick all that apply):
a.      Age (please provide details)
b.      Symptoms (please provide details)
c.      Life expectancy (please provide details)
d.      Contra-indications (please provide details)
e.      Other (please provide details)

5.      Are you using results from the prostate MRI before biopsy to rule
some men out of biopsy as part of the initial diagnostic process? (yes/no)

6.      Do you biopsy all PI-RADS or LIKERT 3 scores?
a.      Yes
b.      No
c.      Dependent on patient histology

7.      What threshold do you mostly use for ruling men out of biopsy?
a.      PI-RADs 3 and above
b.      LIKERT 3 and above
c.      PI-RADs 4 and above
d.      LIKERT 4 and above
e.      Varies depending on age (Please provide detail)
f.      Varies depending on other factors (Please provide detail)

8.      What percentage of men do you estimate are ruled out of biopsy?

9.      Have there been any changes to your prostate MRI capacity in the
last year? (please choose all that apply):
a.      An additional or new MRI scanner
b.      Increased MRI scanner slots for prostate
c.      Agreement to use Dynamic Contrast Enhancement
d.      No longer using Dynamic Contrast Enhancement
e.      A scanner/magnet upgrade
f.      other (free text)

10.     Has the number of radiologists at your trust/health board who
report prostate MRI scans changed in the last year?
a.      Increased
b.      Decreased
c.      Stayed the same

11.     How many radiologists at your trust/health board report at least
250 prostate MRI scans per year?

12. Which of the following processes do you follow to manage men ruled out
of an immediate biopsy, but with a raised PSA?
a. NICE Guidelines: prostate cancer diagnosis and management (NG131)
b. A local protocol (please provide details)
c. Other (please provide details)

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foi (CROYDON HEALTH SERVICES NHS TRUST), Croydon Health Services NHS Trust

Dear Lizzie,
 
FOI REFERENCE NUMBER: 1612

Thank you for your email of 16 August 2019 requesting information Under
the Freedom of Information Act (FOIA) 2000.  I set out below your request
together with our response:
 
1.      Do you routinely conduct prostate MRI (bpMRI/mpMRI) scans before
first prostate biopsy as part of the initial diagnostic process? (please
tick all that apply):
 
a.      Yes, using T2-weighted, diffusion-weighted (multi-b ADC and
high/long b) and dynamic contrast enhanced (DCE) sequences
b.      Yes, using T2-weighted, diffusion-weighted (multi-b ADC and
high/long b) sequences but not DCE (provided no contraindication to MRI)
c.      No but we refer to another provider (please provide details)
d.      No (please provide details)
 
2.      If yes, to 1a: What percentage of men with suspected prostate
cancer receive mpMRI before biopsy as part of the initial diagnostic
process? 0% - We do not have DCE sequence in our current protocol
 
3.      If yes, to 1b: What percentage of men with suspected prostate
cancer receive bpMRI before biopsy as part of the initial diagnostic
process?  All eligible patients are offered an MRI scan
 
4.      What are your eligibility criteria/exclusion criteria for prostate
MRI? (please tick all that apply):
a.      Age (please provide details)
b.      Symptoms (please provide details)
c.      Life expectancy (please provide details)
d.      Contra-indications (please provide details)
e.      Other (please provide details)
There is no age-based restriction on MRI scanning. An MRI scan would not
usually be offered if there is a clinical reason, such as a UTI within the
last three months. However, if there is an overriding clinical suspicion
of prostate cancer, such as an abnormal rectal examination, an MRI will
still be offered. Patients with pacemakers have been offered a referral to
the Royal Brompton Hospital, where there is expertise in performing MRI
scans in patients with pacemakers.
Patients who will not be fit for radical (curative) treatment of prostate
cancer will not be routinely offered an MRI scan. This decision is made on
an individual basis.
 
5.      Are you using results from the prostate MRI before biopsy to rule
some men out of biopsy as part of the initial diagnostic process? (yes/no)
No
 
6.      Do you biopsy all PI-RADS or LIKERT 3 scores?
a.      Yes
b.      No
c.      Dependent on patient histology
 
7.      What threshold do you mostly use for ruling men out of biopsy?
a.      PI-RADs 3 and above
b.      LIKERT 3 and above
c.      PI-RADs 4 and above
d.      LIKERT 4 and above
e.      Varies depending on age (Please provide detail)
f.      Varies depending on other factors (Please provide detail) At
present all men are offered a biopsy unless there is a clinical
contra-indication such as recent infection or health reasons.
 
8.      What percentage of men do you estimate are ruled out of biopsy? We
do not have this information. It is likely to be a small number of men
 
9.      Have there been any changes to your prostate MRI capacity in the
last year? (please choose all that apply): No
a.      An additional or new MRI scanner
b.      Increased MRI scanner slots for prostate
c.      Agreement to use Dynamic Contrast Enhancement
d.      No longer using Dynamic Contrast Enhancement
e.      A scanner/magnet upgrade
f.      other (free text)
 
10.     Has the number of radiologists at your trust/health board who
report prostate MRI scans changed in the last year?
a.      Increased
b.      Decreased
c.      Stayed the same
 
11.     How many radiologists at your trust/health board report at least
250 prostate MRI scans per year? 1 radiologist
 
12. Which of the following processes do you follow to manage men ruled out
of an immediate biopsy, but with a raised PSA?
a. NICE Guidelines: prostate cancer diagnosis and management (NG131) b. A
local protocol (please provide details) c. Other (please provide details)
Men who do not have biopsy are advised PSA follow up based on MDT advice.
This is based on current NICE guidance such as using PSA density. 
 
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Procedure which you may use by writing to The Medical Director,
[1][Croydon Health Services NHS Trust request email].  If you remain unsatisfied you may contact the
Information Commissioner’s Office at Wycliffe House, Water Lane, Wilmslow,
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Thank you for your interest in Croydon Health Services NHS Trust.
 
Yours sincerely
 
FOI Team
Croydon Health Services NHS Trust
Email: [3][email address]
 
 

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