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    DIAGNOSTICS ASSESSMENT PROGRAMME

    Closed for comments This consultation ended on at   Request commenting lead permission

    1 Recommendations

    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 (see section 4).

    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). MRI fusion software overlays the MRI image onto the live ultrasound. 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 software fusion biopsy systems may detect more higher-grade cancers than cognitive fusion biopsy, but this is unclear because few higher-grade tumours 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 fusion software detects higher-grade cancers compared with cognitive fusion. The estimates suggest that fusion biopsy systems could be cost effective compared with cognitive fusion, but because the clinical evidence is uncertain, the cost-effectiveness estimates are uncertain too.

    MRI fusion software shows promise for better detection of prostate cancer and could help to standardise biopsy quality across the NHS, but more evidence is needed.