Acceptability of mpMRI for prostate cancer diagnosis in primary care
Research type
Research Study
Full title
‘Acceptability, understanding and experience of diagnostic tests for prostate cancer: a qualitative study with patients and GPs’
IRAS ID
259602
Contact name
Samuel W D Merriel
Contact email
Sponsor organisation
University of Exeter
Duration of Study in the UK
0 years, 9 months, 31 days
Research summary
Research Summary:
Any new diagnostic test needs to be fully assessed before it is introduced into routine care. As well as ensuring it works, this assessment also includes its cost effectiveness (is it better value than current tests), could it be fitted into current pathways, and if it is acceptable to patients and their clinicians.
In NHS cancer diagnostic pathways some tests can be ordered directly by a patient’s GP, depending on the type of cancer suspected. For prostate cancer, patients are referred directly to the hospital specialists for a diagnostic procedure called a transrectal ultrasound-guided (TRUS) biopsy. 6-12 small tissue samples are taken from different parts of the prostate. This procedure is not ideal: taking the biopsies carries a risk of infection and sepsis, and there is a risk of inaccurate diagnosis as a result of the random nature of the procedure.
Recently it has been shown that using a specialist scanning technique (called Multiparametric MRI [mpMRI]) could identify cancer in the prostate. If used as a preliminary test before a biopsy, mpMRI could help reduce unnecessary biopsies, reduce over-diagnosis of clinically insignificant prostate cancer (that are unlikely to affect a man during his lifetime) and improve detection of clinically significant cancer (that are likely to need to be treated).
We would like to explore how acceptable this potential new test would be for patients and their GPs. We will do this by interviewing men who have had an mpMRI for possible prostate cancer and GPs responsible for referring patients to the current screening pathway. We will ask them to share their experiences and understanding of current practice, and what the proposed scanning technique would mean/have meant to them. The results of this study will contribute to the overall assessment of this potential new test for improving the prostate cancer diagnosis.Summary of Results:
22 patients and 10 GPs kindly agreed to participate in this study. The participants came from across Devon, South London and West London. All the patients had had an mpMRI scan as part of their investigations after being referred by their GP, but each man followed a slightly different pathway to get to that point. Some GPs had experience with their patients having had an mpMRI scan, and others had not. This is not surprising given mpMRI is a relatively new test for prostate cancer and it is currently being rolled out across the NHS.For the patients, there were a few key themes that were mentioned in most of the interviews. Some patients hesitated even using the word ‘cancer’, and they sometimes found that in conversations with their doctors it wasn’t always explicitly raised as a possibility. We called this theme ‘The C Word’. Patients spoke a lot about the importance of clear Communication throughout their experience of being investigated for possible prostate cancer, whether that was with their GP practice, the MRI department at their local hospital, or their Urologist. Each patient’s Pathway experience and the journey that led to an mpMRI scan was slightly different, but many men commented on how quick the process was. Almost all these men said they thought mpMRI was an Acceptable test for the checking the prostate, and would happily have another mpMRI test in the future if it was needed.
For the GPs, there were a number of wider Contextual influences that affected their decision-making and consultations with men with problems relating to their prostate. These included their own personal and professional experiences, as well as the way the NHS works. GPs felt they were often having to make decisions based on Imperfect information, as they are aware that the tests they currently have available for possible prostate cancer have some limitations. GPs used various means in Managing uncertainty, such as seeking advice from their local Urologists, to do the best they could for their patients. GPs feelings on the acceptability of mpMRI were mixed; some thought it sounded like a good idea, but others felt they didn’t have enough experience and understanding of the test right now to make a judgement.
REC name
South West - Frenchay Research Ethics Committee
REC reference
19/SW/0040
Date of REC Opinion
16 May 2019
REC opinion
Further Information Favourable Opinion