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A study looking at 2 scans for prostate cancer (PICTURE)
This study looked at MRI scans and Prostate HistoScanning as ways of diagnosing prostate cancer.
More about this trial
The researchers wanted to look at 2 different ways of scanning the prostate to see if they are as accurate as biopsy results. One is a type of MRI scan called a multi parametric MRI (mpMRI). The other is type of ultrasound scan called Prostate HistoScanning (PHS).
The research team hoped these scans would be better at showing where the cancer is and how big it is.
The aim of this study was to find out how well mpMRI scans and Prostate HistoScanning are at diagnosing prostate cancer.
Summary of results
The research team found that mpMRI scans may be useful, but Prostate Histoscanning is not a reliable test to help diagnose prostate cancer.
This trial was open for people to join between 2012 and 2014, and the team published results in 2017 and 2018.
Results for MRI scans
249 men had a biopsy and an MRI scan. The biopsy was a transperineal prostate mapping (TTPM) biopsy. The MRI scan was a multi parametric MRI (mpMRI) scan. An mpMRI scan shows where different cells, organs and blood vessels are.
If an mpMRI shows there is no prostate cancer, men may not need another biopsy.
The biopsy results showed that:
- 40 men (16%) didn’t have cancer
- 106 men (43%) had prostate cancer that didn’t need treatment
- 103 men (41%) had prostate cancer that needed treatment (clinically significant cancer)
When doctors look at MRI scans for prostate cancer, they give them a score from 1 to 5:
- 1 means there is definitely no cancer
- 2 means there is probably no cancer
- 3 means it’s difficult to tell
- 4 means there probably is cancer
- 5 means there definitely is cancer
First the research team used an MRI score of 3, 4 or 5 to diagnose prostate cancer. The results showed that 35 men (14%) whose MRI was scored 1 or 2 could avoid having a second biopsy. But there is a chance that prostate cancer will be missed in 3 of these 35 men (9%).
Then they used an MRI score of 4 or 5 to diagnose prostate cancer. The results showed that 120 men (48%) whose MRI was scored 1, 2 or 3 could avoid a second biopsy. But there is a chance that prostate cancer will be missed in 20 of these 120 men (17%).
Conclusions about MRI scans
The research team concluded that multi parametric MRI scans could be used to help men avoid having a second biopsy. But it could mean that a small number of cancers are missed. How many will depend on whether doctors use an MRI score of more than 3 or more than 4 to diagnose prostate cancer.
Results for Prostate Histoscanning
220 men had a biopsy and Prostate Histoscanning (PHS). PHS is type of ultrasound scan. Doctors insert a small probe into the rectum, and scan the prostate using the probe.
When the research team compared the results of the biopsies and the PHS, they found that there were some differences.
When we say a ‘positive’ result below, we mean a diagnosis of cancer that needs treatment (clinically significant cancer).
When we say a ‘negative’ result, we mean either a diagnosis of cancer that doesn’t need treatment, or no cancer.
The comparison showed that:
- 64 men had a positive PHS result but a negative biopsy result
- 110 men had a positive PHS result and a positive biopsy result
- 27 men had a negative PHS result but a positive biopsy result
- 19 men had a negative PHS result and a negative biopsy result
The research team found that PHS wasn’t a reliable way to tell the difference between prostate cancer and non cancerous (benign) prostate tissue.
They concluded that PHS is not a useful test to diagnose prostate cancer following an initial biopsy.
Where this information comes from
We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (
How to join a clinical trial
Prof Mark Emberton
Advanced Medical Diagnostics
Experimental Cancer Medicine Centre (ECMC)
University College London (UCL)