Mātai News

New prostate cancer diagnosis pathway launched in Tairāwhiti aims to improve equitable outcomes

The Gisborne Herald, 13 July 2022

A new prostate cancer diagnosis pathway launched by Dr Daniel Cornfeld, of Mātai Medical Research Institute in Gisborne, aims to improve equitable outcomes for Māori and rural men especially.

It is the most common cancer in New Zealand men, with more than 3500 of them diagnosed with prostate cancer and more than 650 deaths each year – about the same as the number of women lost to breast cancer.


It is even worse for Māori men and those living in rural areas where diagnoses are harder to come by, with Māori roughly twice as likely to die following a diagnosis compared with non-Māori, because it is often found too late to cure.


A “game-changing” three-year pilot being run in Tairāwhiti/Gisborne aims to address that, improving accuracy and equity in prostate cancer diagnosis. Gisborne-based research centre Mātai Medical Research Institute – Mātai meaning “to investigate or examine” – is soon to launch a new diagnosis programme which will cut scan times in half and lead to more targeted biopsies.


Leading the project will be Dr Daniel Cornfeld, Mātai’s clinical lead and honorary senior lecturer at the University of Auckland. The former chief of abdominal MRI (magnetic resonance imaging) at Yale-New Haven Hospital and associate professor of radiology at the Yale University school of medicine, Cornfeld also works at Hauora Tairāwhiti, Gisborne’s public hospital.


He said the project would help address deficiencies in current biopsy techniques.


Traditionally, diagnosis is carried out through untargeted biopsies ordered for men with high prostate-specific antigen (PSA) blood test results.


However, that method could lead to over-diagnosis, under-diagnosis, and tumour mis-characterisation, Cornfeld said. “We can do a better job and do it equitably.”


Some urologists across the country were qualified to practise cognitive fusion (informed biopsies), leading to slightly more targeted biopsies, but they were in the minority as it was a “very acquired skill”.


A new biopsy machine – set to arrive later next month – will allow the team at Mātai to carry out pre-biopsy MRIs and guided biopsies, allowing for correlation between the size, location and grade of detected tumours. Donated by the Hugh Green Foundation, it will be “accurate up to 3mm”.


That opened the door for personalised treatments, Cornfeld said. Currently, MRI guided biopsy was only available at a handful of private practices.


Partnering with GE Healthcare, Mātai’s advanced MRI scanner had also allowed it to develop a complete MRI prostate scan that would take 15-20 minutes – cutting the current standard scan time of 45 minutes in half.


This project was not designed to be a screening programme. However, the guided biopsy reduced the incidence of inaccurate diagnosis and therefore the risks associated with screening.


“Once the pathway is proven, we would like to encourage the use of the MRI guided biopsy method as a general standard for prostate cancer diagnosis in New Zealand.


“The ultimate goal is to eliminate the late diagnosis of prostate cancer in our region,” Cornfeld said, adding that Tairāwhiti’s population size would allow Mātai to trial the programme without overwhelming it.


Mātai plans to continue with the pathway in Tairāwhiti beyond the initial pilot, with capacity to image all men aged 40-70 years old who are at risk for prostate cancer within the next 10 years.


Peter Dickens, chief executive of the Prostate Cancer Foundation of NZ, said it was an important initiative which could bringAotearoa New Zealand into line with best diagnostic practice globally.


“What is particularly exciting is that it is planned to take place in communities we know, through research, have experienced significant inequities in terms of disproportionately poorer rates of accurate diagnosis and sadly poorer outcomes as a result.”