GU cancer

Prostate MRI tipped for MBS item


Federal Health Minister Greg Hunt has signalled that MRI scans for men with suspected prostate cancer will receive MBS rebate funding in the upcoming May 2018 Budget.

The move follows a recent recommendation by the Medicare Services Advisory Committee (MSAC) for the listing of multiparametic MRI (mpMRI) of the prostate for both the diagnosis of suspected prostate cancer and the active surveillance of patients with a proven diagnosis of prostate cancer.

The MSAC recommendation was based on studies showing that imaging of the prostate with mpMRI before biopsy could halve the number of men that need a biopsy, thus preventing overtreatment and its associated adverse effects such as incontinence and impotence.

“And the MRI and targeted biopsy pathway is more accurate than random TRUS biopsies and also gives a better grading of the patient’s particular tumour and uses 90% less needles,” the MSAC review summary noted.

The health minister has previously said he would like to see MRI funded for men with prostate cancer, describing it as a “historic anomaly” that there are MBS items for MRI for women with breast cancer but not for men with prostate cancer.

“The Minister is confident of making a positive announcement on this decision in the near future,” his office said in a statement to the media on 11 April.

According to the MSAC proposal, patients would have to be referred by a radiation oncologist, medical oncologist or urologist.

In its evaluation, MSAC noted the superior safety and equivalent efficacy of mpMRI compared to ultrasound-guided biopsy, and said the cost of providing mpMRI would be offset by avoiding many biopsies..

MSAC also noted mpMRI of the prostate has been available privately in Australia since 2012 – creating a significant equity issue ‘due to an individual’s ability to pay out of pocket costs’.

The Urological Society of Australia and New Zealand have recently endorsed the use of MRI to improve the prostate cancer diagnostic pathway.

This follows the PRECISION study findings that MRI following an elevated PSA result can help decide whether a biopsy is necessary.

“We expect this important study will add to the body of evidence currently under review as the Government decides whether to reimburse this technology for prostate cancer diagnosis for men who need it,” USANZ spokesman Professor Shomik Sengupta said.

“If we can safely reduce the number of biopsies, not only would this eliminate unnecessary discomfort and complications, but would also represent a significant costs saving, since the cost of a biopsy is substantially higher than a MRS scan.”

He added the benefits of the technology would only as good as the skill of the operator – specialists with appropriate experience and expertise.

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