The thought of being investigated for prostate cancer terrified Paul Davies. About a year ago, Mr Davies was told to see a urologist about a high PSA (prostate-specific antigen) blood test.
He was horrified. Having watched a friend go through a prostate cancer diagnosis and treatment, he knew it could involve painful biopsies that carry an infection risk, and surgery that might lead to incontinence and sexual dysfunction.
The Melbourne business owner also knew that there was a history of men being "overdiagnosed" with cancers that were so slow growing they were never going to cause harm.
"It's scary ... You want to get the best test done but you don't want to do things that are unnecessary," he said.
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Mr Davies, 68, was in luck. When he saw his urologist, Associate Professor Jeremy Grummet, the doctor had started using MRI scans to see if it could help some men avoid a biopsy. He was also using MRI scans to highlight suspicious areas so he could better target a biopsy if required.
As it turned out, the MRI showed Mr Davis had an enlarged prostate that could be treated with medication, and no tumours. He was relieved. He didn't need a biopsy, and his follow up PSA tests dropped back to normal.
In Australia, about one in five urologists are using MRI scans to investigate prostate cancer, but new research suggests use will surge.
A British study of nearly 600 men, published in The Lancet medical journal on Friday, found using an MRI scan for men with symptoms of prostate cancer or a high PSA test could prevent one in four men from having an unnecessary biopsy – a test which can cause serious, and in rare cases, life-threatening infections when done through the rectum.
Using MRIs can also reduce the number of men overdiagnosed with harmless forms of prostate cancer by about 5 per cent while improving the detection of aggressive cancers, the researchers concluded.
In the Lancet study, the MRI correctly diagnosed 93 per cent of aggressive cancers compared to an ultrasound-guided biopsy through the rectum which diagnosed 48 per cent.
Furthermore, for men who had a negative MRI scan, nine out of 10 had no cancer or a harmless cancer. In comparison, standard biopsies done without a previous MRI scan to help the surgeon target the right areas of the prostate miss up to 30 per cent of cancers.
Because some cancers are still missed with MRI scans, Associate Professor Grummet said men with negative results could choose to have ongoing surveillance after their first scan with more PSA tests and MRIs, rather than going down the path of a potentially harmful biopsy.
However, he said MRIs cost about $400 and need to be done by an experienced radiologist. He and other urologists are now hoping this research, together with Australian studies, will help convince Medicare to subsidise MRI scans.
"We're hoping Medicare will agree to a rebate this year so that it becomes more affordable," said Associate Professor Grummet.
About 22,000 Australian men are diagnosed with prostate cancer every year and about 3300 die from it.