HNY Policy and Pathway Repository - Hull

Suspected prostate cancer

This intervention is only commissioned when used in accordance with the recommendations specified in the Academy of Medical Royal Colleges (AoMRC) Evidence Based Interventions (EBI) programme: Needle biopsy of prostate - EBI

Standardised cancer care pathways are essential for equitable access. According to NHS guidelines during COVID-19, suspected prostate cancer patients should first undergo virtual triage. High-quality mpMRI before biopsy improves outcomes, with the PROMIS study showing 93% sensitivity for clinically significant prostate cancer and indicating that about 25% of patients can avoid biopsy. Cost analyses show mpMRI is cost-effective. The PRECISION trial found that mpMRI-guided biopsy detects more cancers and reduces unnecessary biopsies compared to TRUS alone; as a result, EUA and NICE now recommend mpMRI as the initial diagnostic in biopsy-naïve patients.

 

However, up to 28% of patients with low-risk MRI may still have clinically significant cancer, so shared decision-making is crucial. While some centres use bpMRI, current guidelines support mpMRI due to better diagnostic accuracy. Both the Likert and PI-RADS systems are valid for reporting mpMRI, though the Likert scale may be more effective in expert centres. Further research is needed on transrectal versus transperineal biopsy, but LATP is associated with fewer complications and supports antibiotic stewardship. There’s a trend toward the transperineal approach, which is recommended as first-line where feasible.

 

This approach aims to standardise practice, minimise variations between NHS trusts, and reduce general anaesthetic use—facilitating community-based diagnosis, lowering risks, and improving resource allocation.

Needle biopsy of prostate - EBI