Urology department MRI use for Prostate Cancer Diagnosis

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Dear East Lancashire Hospitals 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)

Freedom of Information (ELHT) Mailbox, East Lancashire Hospitals NHS Trust

Thank you for your Freedom of Information Request under the terms of the Freedom of Information Act 2000. Your reference for this is – Ref: 2019/08/19 Ellis L

Under the Act, the department is required to provide you with a response within 20 working days. We will write to you in response to your request for information by the 17th September 2019.

The Freedom of Information Act includes a number of exemptions to releasing information. Some of these are qualified exemptions which require us to consider whether it is in the public interest to disclose or withhold the information. In these circumstances we may need more time to consider your request, and if this is the case we will write to you by the date above to inform you of when you can expect to receive a response. If you have any queries regarding this request please do not hesitate to contact me, quoting the reference number at the top of this email in all future correspondence.

Details of how we will process your request are available on our website at: http://www.elht.nhs.uk/freedom-of-inform...

Yours sincerely

Freedom of Information Team
East Lancashire Hospitals NHS Trust

[email address]

Website: www.elht.nhs.uk
Twitter: www.twitter.com/EastLancsHosp
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Royal Blackburn Hospital | Haslingden Road | Blackburn | Lancashire | BB2 3HH
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Freedom of Information (ELHT) Mailbox, East Lancashire Hospitals NHS Trust

Dear Ms Ellis,
Thank you for your Freedom of Information Request under the terms of the Freedom of Information Act 2000. Please find the response to your questions below.

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)
ANSWER - A

2. If yes, to 1a: What percentage of men with suspected prostate cancer receive mpMRI before biopsy as part of the initial diagnostic process?
ANSWER - 100% of the ones which would be suitable for radical treatment

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

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)
ANSWER - E - If suitable for radical treatment

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)
ANSWER - YES, however rule out is not an appropriate term. If the PSA is >10 (or pre-test risk >25% using a calculator – they roughly equate to the same thing) or the PSA continues to rise, even if MRI is normal, we may still perform a biopsy.

6. Do you biopsy all PI-RADS or LIKERT 3 scores?
a. Yes
b. No
c. Dependent on patient histology
ANSWER - B - We advise patients to have biopsy but they often refuse so we then offer PSA monitoring

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)
ANSWER - We don’t perform a biopsy if the PI-RADS/LIKERT (we use the terms interchangeably, essentially we mean LIKERT) is BELOW 3 AND the pre-test risk <25%/PSA<10.

8. What percentage of men do you estimate are ruled out of biopsy?
ANSWER - We are currently undertaking an audit on this.

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)
ANSWER - We roughly levelled out the number of prostate MRIs we were doing about 2-3 years ago, just before we started the pre-biopsy MRI. Doing pre-biopsy MRI hasn’t obviously changed the number of scans we have done.

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
ANSWER - C

11. How many radiologists at your trust/health board report at least 250 prostate MRI scans per year?
ANSWER - 2

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) ANSWER C = PSA follow-up

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Freedom of Information Team
East Lancashire Hospitals NHS Trust
[email address]
Website: www.elht.nhs.uk
Twitter: www.twitter.com/EastLancsHosp
Facebook: www.facebook.com/EastLancashireHospitals

Parkview Offices | Royal Blackburn Hospital | Haslingden Road | Blackburn | Lancashire | BB2 3HH The information contained in this email may be privileged. It is intended for the addressee only. If you are not the intended recipient, or the designated substitute, please notify the sender and delete this email immediately. The contents of this email must not be disclosed without the sender's consent. We cannot accept any responsibility for viruses, so please scan all attachments.
Please consider the environment before printing this e-mail

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