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Urology department MRI use for Prostate Cancer Diagnosis

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Dear Maidstone and Tunbridge Wells 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)

FOIadmin (MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST), Maidstone and Tunbridge Wells NHS Trust

1 Attachment

Dear Ms Ellis

 

Please see the attached letter.

 

Many thanks.

 

On behalf of the Information Governance Department

Email: [1][email address]

 

Completed Freedom of Information requests are published on the Trust
website [2]http://www.mtw.nhs.uk/freedom-of-informa...

 

This transmission is intended for the named recipient only and is
confidential in nature. If received in error, please return it to the
sender and delete any copies.The information contained in this email may
be subject to public disclosure under the NHS Code of Openness or the
Freedom of Information Act 2000 (unless legally exempt from
disclosure).Additionally, any personal information recorded within the
email may be subject to Data Protection legislation.If your email is a
request for information under the Freedom of Information Act 2000, please
forward it to FOI admin who will action your request. Email:
[3][email address]  or write to FOI admin, Trust Management,
Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Hermitage
Lane, Maidstone, ME16 9QQ

 

 

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Dear FOIadmin (MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST),

Further to our Freedom of Information request of 20th August 2019, we have received a large number of responses, however, we are still awaiting a response from your Trust. Please provide a response as soon as possible as the deadline has passed.
Please let me know if you are having any problems completing the request.

Yours sincerely,

Lizzie Ellis

FOIadmin (MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST), Maidstone and Tunbridge Wells NHS Trust

Dear Ms Ellis

Thank you for your email.

I have chased the department concerned and asked that they respond as a matter of urgency.

I will of course continue to chase them until the information is received.

Please accept my apologies for the delay in our response to your request.

Many thanks.

On behalf of the Information Governance Department
Email: [email address]

Completed Freedom of Information requests are published on the Trust website http://www.mtw.nhs.uk/freedom-of-informa...

This transmission is intended for the named recipient only and is confidential in nature. If received in error, please return it to the sender and delete any copies.The information contained in this email may be subject to public disclosure under the NHS Code of Openness or the Freedom of Information Act 2000 (unless legally exempt from disclosure).Additionally, any personal information recorded within the email may be subject to Data Protection legislation.If your email is a request for information under the Freedom of Information Act 2000, please forward it to FOI admin who will action your request. Email: [email address] or write to FOI admin, Trust Management, Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Hermitage Lane, Maidstone, ME16 9QQ

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Dear FOIadmin (MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST),

Could you please advise as to when this FOI request will be completed?

Yours sincerely,

Lizzie Ellis

FOIadmin (MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST), Maidstone and Tunbridge Wells NHS Trust

Dear Ms Ellis

Thank you for your email.

I have again chased the department and escalated this to both my Manager and the Divisional Lead for the department concerned.

I am hoping this will mean a timely response from them.

I will of course continue to chase them until the information is received.

Again my apologies for the delay in our response to your request.

Many thanks.

On behalf of the Information Governance Department
Email: [email address]

Completed Freedom of Information requests are published on the Trust website http://www.mtw.nhs.uk/freedom-of-informa...

This transmission is intended for the named recipient only and is confidential in nature. If received in error, please return it to the sender and delete any copies.The information contained in this email may be subject to public disclosure under the NHS Code of Openness or the Freedom of Information Act 2000 (unless legally exempt from disclosure).Additionally, any personal information recorded within the email may be subject to Data Protection legislation.If your email is a request for information under the Freedom of Information Act 2000, please forward it to FOI admin who will action your request. Email: [email address] or write to FOI admin, Trust Management, Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Hermitage Lane, Maidstone, ME16 9QQ

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Dear FOIadmin (MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST),

Could I please have an update on the above FOI request, and please can I receive this FOI response by the 18th December?

Yours sincerely,

Lizzie Ellis

FOIadmin (MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST), Maidstone and Tunbridge Wells NHS Trust

Dear Ms Ellis

Thank you for your email.

I have again chased the department and again escalated this to both my Manager, the Divisional Lead and the Chief of Service for the department concerned.

I will of course continue to chase them until the information is received.

Again my apologies for the delay in our response to your request.

Many thanks.

On behalf of the Information Governance Department
Email: [email address]

Completed Freedom of Information requests are published on the Trust website http://www.mtw.nhs.uk/freedom-of-informa...

This transmission is intended for the named recipient only and is confidential in nature. If received in error, please return it to the sender and delete any copies.The information contained in this email may be subject to public disclosure under the NHS Code of Openness or the Freedom of Information Act 2000 (unless legally exempt from disclosure).Additionally, any personal information recorded within the email may be subject to Data Protection legislation.If your email is a request for information under the Freedom of Information Act 2000, please forward it to FOI admin who will action your request. Email: [email address] or write to FOI admin, Trust Management, Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Hermitage Lane, Maidstone, ME16 9QQ

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TAYLOR, Henry (MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST), Maidstone and Tunbridge Wells NHS Trust

Dear Sir

FOI request response - MTW NHS Trust

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? 70% - all for whom curative treatment is an option

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) - all for whom curative treatment
is an option

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

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?
10% - we are starting conservatively

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? 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)

best wishes

Dr Henry Taylor
Consultant Clinical Oncologist 
Chief of Service, MTW Cancer Services
Kent Oncology Centre
Maidstone Hospital
Tel 01622 225288
Fax 01622 225074
 
If your email is a request for information under the Freedom of
Information Act 2000,
please forward it to [1][email address] who will action your request.

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Dear TAYLOR, Henry (MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST),

Thank you very much for your response to our FOI. I have noticed a few questions that seem to not have been answered (6, 7, 9, 10, 12). I am wondering whether this is because bold text does not show up on this platform, or whether there was no answer given? Could I ask that if it is the former, would we be able to have an X placed against your answer?

I hope that is ok and apologies for any inconvenience.

Yours sincerely,

Lizzie Ellis

TAYLOR, Henry (MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST), Maidstone and Tunbridge Wells NHS Trust

Dear Sir

FOI request response - MTW NHS Trust

Updated response to indicate responses more clearly

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):

b. Yes, using T2-weighted, diffusion-weighted (multi-b ADC and high/long b) sequences but not DCE X

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

3. If yes, to 1b: What percentage of men with suspected prostate cancer receive bpMRI before biopsy as part of the initial diagnostic process? 70% - all for whom curative treatment is an option

4. What are your eligibility criteria/exclusion criteria for prostate MRI? (please tick all that apply):

e. Other (please provide details) - all for whom curative treatment is an option X

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

6. Do you biopsy all PI-RADS or LIKERT 3 scores?
a. Yes X

7. What threshold do you mostly use for ruling men out of biopsy?
a. PI-RADs 3 and above X

8. What percentage of men do you estimate are ruled out of biopsy? 10% - we are starting conservatively

9. Have there been any changes to your prostate MRI capacity in the last year? (please choose all that apply):

b. Increased MRI scanner slots for prostate X

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

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

best wishes

Dr Henry Taylor
Consultant Clinical Oncologist
Chief of Service, MTW Cancer Services
Kent Oncology Centre
Maidstone Hospital
Tel 01622 225288

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We don't know whether the most recent response to this request contains information or not – if you are Lizzie Ellis please sign in and let everyone know.