1.1 There is not enough evidence to recommend routine adoption of MRI fusion biopsy systems for diagnosing prostate cancer. Centres already using MRI fusion biopsy systems to diagnose prostate cancer may continue to do so but are encouraged to collect data or do further research.
1.2 Further data collection and research is recommended (see the section on further research) to:
assess the performance of MRI fusion biopsy systems compared with cognitive fusion biopsies to detect different grades of prostate cancer
assess the impact of using the technology on the rate at which biopsies can be done, and on service capacity to do biopsies.
Why the committee made these recommendations
Biopsies for suspected prostate cancer are done using previously taken MRI images and live ultrasound imaging to help the operator guide the biopsy needle (cognitive fusion). In MRI fusion biopsy systems, software overlays the MRI image onto the live ultrasound image (MRI fusion). This could mean fewer cases of prostate cancer are missed and could reduce the number of repeat biopsies.
The clinical evidence is limited because none of the studies are from the UK and none are of high quality. It suggests MRI fusion biopsy systems may detect more higher-grade cancers than with cognitive fusion biopsy, but this is unclear because few higher-grade cancers were detected overall. There is not much evidence comparing the different software fusion technologies with each other. And the technologies differ in their features, so it is not clear if any are better than the others.
The cost-effectiveness estimates depend on how well MRI fusion biopsy systems detect higher-grade cancers compared with cognitive fusion. The estimates suggest that MRI fusion biopsy systems could be cost effective compared with cognitive fusion, but because the clinical evidence is uncertain, the cost-effectiveness estimates are very uncertain.
MRI fusion biopsy systems show promise for better detection of prostate cancer and could help to standardise biopsy quality across the NHS, but more evidence is needed.