Matai Medical Research Institute’s new cancer diagnostic pathway project — Accuracy and Equity in Prostate Cancer Diagnosis — is a New Zealand first. Led by Matai clinical lead Dr Daniel Cornfeld, it is aimed at vastly improving New Zealand’s diagnostic pathway in prostate cancer for patients in the public health system, particularly those who live in under-served and remote communities. Dr Cornfeld said the project would chart the efficacy in New Zealand of a model-of-care approach for patients. It will use the latest evidence-based methods adopted in prostate cancer diagnostic pathways in the United States, United Kingdom and other parts of Europe. “Because we are based in Tairawhiti Gisborne, we have a unique opportunity to provide a relatively remote community with access to world-class medical care,” Dr Cornfeld said. “The research carried out in the region aims to validate a best-practice prostate cancer diagnosis pathway that can be rolled out across the country.”

The Matai pathway will initially be validated with patients in the Tairawhiti Gisborne region and will draw on the power of the magnetic resonance imaging (MRI) scanning technology and software at Matai. Dr Cornfeld told The Gisborne Herald the fully-scoped project was ready to begin once funding was found. “If we can raise sponsorship/philanthropic funding of $670,000 we could begin the project immediately and keep it going for a year. “Then we would continue fundraising efforts to extend this further. “Alternatively, we will continue to push for research grant funding, which could take up to a year to obtain.”

The project is a collaboration between Matai, primary care and community health groups. It involves a local and international multi-disciplinary research team, including radiologists, urologists, imaging processing PhDs, GE Healthcare scientists and community leaders.

Community and regional partnerships, including those with iwi, will play a key role to engage a balanced representation of local Maori men as participants in the study. They will be selected and counselled through a new prostate cancer outreach and education programme. “Matai will perform outreach to GPs, local iwi,and tangata whenua to educate about the risks and benefits of being screened for prostate cancer given the availability of pre-biopsy MRI and guided biopsy,” Dr Cornfeld said. “With this knowledge, men can have informed conversations with their GPs regarding having a PSA (prostate-specific antigen) test and digital rectal exam. Patients with abnormal results would be eligible for enrolment in the pathway.”

The project was not a screening programme but was intended to provide better information to those who had been screened, he said.

With present screening for prostate cancer, it was tricky to tell how big the cancer was, which meant some cancers that did not need treatment were treated, while others that did need treatment could be missed. “If we are going to identify cancers early, you only want to treat the cancers that are going to end up being a problem. “The thought is if you do the imaging before the biopsy and then you do the biopsy based on the imaging, then you correlate the two together. “It makes it a lot easier to figure out whether it will be a problem and you can treat it . . . or you don’t need to treat it. “Our ultimate goal would be to prevent men from presenting with untreatable metastatic disease.”

Matai’s GE Healthcare 3T MRI scanner will be an integral tool to help achieve the accuracy and equity goals of the pathway. The MRI will be used to introduce pre-biopsy scans to the diagnostic pathway for patients as well as to guide a new targeted biopsy technique. Pre-biopsy MRI identifies 30 percent of men with elevated PSA who do not require a biopsy.