Wrexham Maelor Hospital’s Urology Unit was one of 11 units across England and Wales which took part in the Prostate MRI imaging study (PROMIS) trial to discover improved ways of diagnosing prostate cancer.
The results showed 27 per cent of men who had a negative MP-MRI did not need a biopsy at all.
Crucially, 93 per cent of aggressive cancers were detected by using the MP-MRI scan to guide the biopsy, compared with just 48 per cent where only a TRUS biopsy was carried out.
When I raised this in the Chamber last March, I quoted the North Wales Community Health Council welcoming the Health Minister’s “commitment to expect Health Boards to revise their diagnostic pathways to incorporate these scans, if recommended by the National Institute for Health and Care Excellence – or NICE - in revised guidelines after April 2019, but also expressing concern that this would be too late, that patients in North Wales will continue to be left behind, and that their discussions with Urologists in North Wales suggest that we need to be developing the service now, in preparation for NICE accreditation”.
Noting that NICE Guidance already stated that mpMRI scans should be considered for men with a negative transrectal ultrasound 10–12 core biopsy to determine whether another biopsy is needed - I referred to constituents in North Wales who met this criteria but who had then had to pay around £900 to fund these scans because they were not provided or funded by the Health Board in North Wales.
Three of my constituents then wrote to the Minister confirming that they had had to pay – and stating that they had watched this and seen him “smirk and laugh at them”.
After raising this again with the Health Minister last April, they told me that “his statement to the Senedd that service provision in the Welsh NHS is in line with NICE guidelines is patently not true, as you evidenced in your question’”.
Another patient told me last March’s “announcement by NHS England that it was launching a one-stop service using MRI techniques to revolutionise prostate cancer treatment and slash the time taken for a diagnosis there was a ‘game changer’, and patients across Wales should not be left behind”.
Last December, NICE issued new draft guidance recommending pre-biopsy mpMRI for suspected Prostate Cancer, with final guidance expected next month.
In January, the Health Minister wrote to members stating that he had asked all Health Boards to work with the Welsh Urology Board to ensure that they have full implementation plans within one month of this.
In the same letter he stated that “Health Boards have confirmed that at present they deliver care in line with current NICE Guidance”.
North Wales patients reiterated that care was not delivered in line with current NICE Guidance in their cases.
North Wales Community Health Council stated that the Health Board have consistently declined to produce proof that they did any scans for men with rising PSA following a negative biopsy – and that they are co-ordinating refunds to all of their clients who did not receive scans in line with the 2014 guidance.
They also state that their correspondence with the Health Minister gives them no comfort that he will intervene if they make the same decision on the pre-biopsy mpMRI guidance.
This petition’s sponsor, Stuart Davies, states that interim arrangements should be put in place now so that men do not put their lives at risk, that although patients pay approximately £900, the cost to the NHS at Wrexham’s Spire Hospital is only £365 – and that men contacting the campaign say that they are either waiting for it to become free or are taking out loans to pay for their scan.
Last December, I attended a meeting with Mr Davies, the Health Board and Community Health Council, at which the Health Board apologised and offered to refund the money men had paid for scans.
However, only this week, a constituent received a letter from the Health Board stating that “although current clinical advice suggests that the use of full diagnostic mpMRI may be beneficial … this has not yet been supported by NICE”.
Noting that NICE has now backed mpMRI scans as a cost effective first-line investigation, Tenovus Cancer Care have called on the Welsh Government to ensure that mpMRI is available across Wales, stating that it is not available at Betsi Cadwaladr, Hywel Dda or Swansea Bay, and not available at PROMIS standards in Cardiff and Vale.
However, as Prostate Cancer UK states, mpMRI revolutionises Prostate Cancer diagnosis.