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Q and A about Prostate HistoScanning by Miss Lucy Simmons

Lucy qualified in Medicine from Newcastle University. She is currently a clinical research fellow at University College London & University College London Hospitals Trust where she is undertaking a postgraduate medical research degree under the supervision of Professor Mark Emberton and his team. Her research focuses on a novel imaging technology for prostate cancer detection- Prostate HistoScanning™.

In May Lucy took part in the BUPA London 10km race, raising £1275 for the Prostate Cancer Research Centre.

What is Prostate HistoScanning™?

Prostate HistoScanning™, is a new 3D ultrasound imaging technology that utilises the raw data usually obtained but not show, during prostate ultrasound. It aims to  distinguish the tissue characterisation signals that are normal from those that may be indicative of prostate cancer. Consequently Prostate HistoScanning gives a prediction in the form of a picture of the presence or absence and location of prostate cancer within the prostate.

Why do we need Prostate HistoScanning™?

Prostate cancer is a major health issue facing the men in our lives. It is the most common cancer in the UK accounting for nearly a quarter of all new male cancers. Yet it remains one of the only solid organ cancers where there is no established imaging test widely available to aid diagnosis.

In the UK the standard practice for investigating prostate cancer includes a digital rectal examination (DRE) of the prostate by your doctor to feel for any abnormal lumps on the prostate and a blood test called Prostate Specific Antigen (PSA) which, if raised, may help the doctor work out if a man is at risk for prostate cancer. When one or both of these tests are suspicious for prostate cancer, men are normally referred to a urology doctor for biopsies of the prostate and diagnosis.

Biopsies of the prostate are taken using an ultrasound probe that is placed in the back passage and used to guide needles into the prostate. In most places around the UK this procedure is still performed in an untargeted manner  i.e. the doctor will take a number of biopsies from predetermined areas in the prostate- usually 8 to 12 samples depending the size of the prostate. The biopsy process is an unavoidably invasive test with most men experiencing bleeding after the procedure either in the waterworks or from the back passage. Also, due to the needles passing through the back passage into the prostate, the biopsy test carries a 4% risk of infection. Because of the untargeted technique used, some significant cancers can be missed by chance, or because they are in an area not commonly sampled. Also, as many men develop small harmless prostate cancers as they age, these can be detected on biopsy.  Uncertainty over whether this might be part of a larger cancer means that some men will have these cancers treated unnecessarily. 

 In other cancers, such as breast cancer, it is common to perform a targeted biopsy, where women with a normal imaging test (mammogram) do not have a biopsy, and those with an abnormal imaging test have only that abnormal area sampled with a biopsy. 

Many doctors think that there is a need for a widely available imaging technique, such as Prostate HistoScanning™, to have a similar role in the diagnosis of prostate cancer.

 What does a Prostate HistoScanning™ test involve?

A Prostate HistoScanning™ test is very similar to a standard transrectal ultrasound of the prostate. Men are asked to empty their bladder and bowel prior to the procedure. They are requested to lie on their left hand side and an ultrasound probe is inserted into the back passage. With the aid of a hand held motor, the probe is rotated slowly through 180 degrees to capture a full set of 3 dimensional data of the prostate gland.

This data is then analysed by the Prostate HistoScanning™ software. When areas suspected to be cancer are detected, these are mapped as red areas on the ultrasound image, with the prostate boundary outlined in yellow, as seen in this picture which shows a transverse slice through the prostate. 

How good is HistoScanning™ at detecting prostate cancer?

There are now more than 30 Prostate HistoScanning™ centres across Europe and the clinical evidence in support of the technology is increasing.  The latest results indicate that Prostate HistoScanning™ shows potential to accurately detect and localise cancerous lesions within the prostate.

However this technique still requires further verification and clinical trials are currently underway to investigate the potential role of Prostate HistoScanning™ for prostate cancer detection. Many imaging tests are undergoing evaluation for their usefulness in prostate cancer diagnosis- Prostate HistoScanning™ is just one of the possible modalities.

Should anyone be interested in this new technique or other clinical trials for the diagnosis of Prostate Cancer please ask your doctor to refer you to -

Professor Mark Emberton

Department of Urology

University College London Hospitals Trust

250 Euston Road

NW1 2PG.