International perspectives on prostate cancer diagnosis and care

Following a CanTest Travelling Fellowship award, Dr Sam Merriel, GP and Senior Clinical Research Fellow at the University of Exeter, talks about his participation in the 20th Asia-Pacific Prostate Cancer Conference in Melbourne and early outputs from his work.

In August 2019, the 20th Asia-Pacific Prostate Cancer Conference was held in Melbourne. Hosted by the Australian Prostate Centre, the meeting brought together world leaders in prostate cancer care and research under the theme of ‘Together in discovery and care’. Numerous aspects of care for men with prostate cancer were discussed and debated, with the latest research and best practice from many countries and institutions being shared amongst the attendees. The current challenges around the accurate diagnosis of prostate cancer was a common topic of discussion, which included sharing the results of the first study from my CanTest funded PhD, assessing patient centred outcomes from diagnostic tests for prostate cancer.

The conference was chaired by Prof Anthony Costello AM, Director of Urology at the Royal Melbourne Hospital. Through an earlier CanTest Travelling Fellowship I had the opportunity to network with members of the Australian Prostate Centre and meet Prof Costello. Together we developed a modified Delphi study to seek consensus amongst the prostate cancer experts attending the conference around active surveillance for prostate cancer. In the lead up to the conference, the study participants completed questionnaires on the best practice of active surveillance. These informed draft consensus statements that were debated and refined in a conference workshop. We hope to bring this all together into a publication in the Journal of Urology very soon.

Already published in JAMA Network Open is a systematic review and meta-analysis that compares multiparametric magnetic resonance imaging (mpMRI) and targeted biopsy with systematic biopsy alone for the diagnosis of prostate cancer. We found mpMRI with targeted biopsy was associated with improved detection of clinically significant prostate cancer compared to ultrasound guided systematic biopsy. We also found pre-biopsy mpMRI may result in fewer biopsies taken per procedure, reduced adverse effects for patients, and could be used to avoid biopsy altogether in some men. Our findings support the central tenant of my PhD that pre-biopsy mpMRI has a role to play as a triage test for prostate cancer.

During my visit to Melbourne, I spoke to the Primary Care Collaborative Cancer Clinical Trials Group (PC4) about the findings from the JAMA systematic review and the role of mpMRI in prostate cancer diagnosis. You can listen to this discussion in their latest Research Round-up podcast.

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