Diolch, Dirprwy Lywydd. This evening’s debate will focus on a petition submitted by Stuart Davies, who lives in the constituency of Clwyd South. It calls for all men in Wales to have access through the NHS to the best possible diagnostic tests for prostate cancer. The petition received 6,345 signatures and the Petitions Committee is grateful for the opportunity to bring this petition to the Assembly today, under the process whereby the committee considers the merits of holding a debate on a petition that receives more than 5,000 signatures.

It is worth noting here that prostate cancer is the most common cancer for men in Wales, with more than 2,500 men diagnosed in Wales every year. Mr. Davies’s petition calls for the latest prostate screening technology to be available to all men where there is a suspicion of prostate cancer. Specifically, the technology is the multiparametric MRI scan, or mpMRI. This combines up to three different types of scan in order to provide a clearer picture of the prostate gland. It is different to standard MRI scans, which are rarely clear enough to facilitate a confident diagnosis of prostate cancer at an early stage.

Up to now, men have typically needed to undergo a biopsy to diagnose prostate cancer. These are invasive and painful, and the potential side effects can include bleeding and infection. They may also miss up to one in five cancers of the prostate, because the precise location of the cancer is unknown when the biopsy is carried out. Alongside biopsy, the most commonly used tests for diagnosing prostate cancer include a blood test and physical examination of the prostate.

A study published in February 2017, known as PROMIS, found that using an mpMRI scan could reduce the number of unnecessary biopsies and improve the detection of clinically significant cancer. The petition is seeking access to mpMRI scans for all men in Wales as a priority, in order to improve diagnosis and reduce the number of men having to undergo biopsies. Prostate Cancer UK is also campaigning for increased access to mpMRI across the United Kingdom.

The National Institute for Health and Care Excellence, NICE, is currently in process of revising their guidance in relation to the diagnosis and management of prostate cancer. This review includes an assessment of the latest evidence, including the PROMIS study. In December, NICE published new draft guidance for consultation. It includes a recommendation for mpMRI scans to be used as a first line investigation for people with suspected prostate cancer, as called for in the petition.

The guideline proposes that patients should still undergo a blood test initially, with an mpMRI used to better detect suspected clinically significant prostate cancer. NICE states that the scan can help clinicians understand the location of the cancer and target the biopsy directly, reducing the time taken to accurately identify the cancer and the need for multiple biopsies. Therefore, it is expected that increased use of mpMRI will prove cost effective by reducing the number of biopsies performed and the need for further treatment, because cancers are more likely to be detected and identified earlier. The final guideline is expected to be published at the end of April.

The petitioner and Prostate Cancer UK both argue that the current situation is inequitable. A number of areas already offer access to mpMRI scans. In Wales, Cwm Taf and Aneurin Bevan health boards routinely provide mpMRI scans for suspected prostate cancer. Another, Cardiff and Vale health board, offers pre-biopsy MRI scans, though not the full specification targeted by the campaign. This leaves patients in west, north and parts of south Wales currently unable to access the tests, whilst patients in Powys are generally referred elsewhere. In areas where the scans are not available, the petitioner states that he and other men with suspected prostate cancer have faced paying £900 to have one done privately. He has pointed out that a trial was previously carried out in Wrexham Maelor Hospital, but the scans are not currently available on the NHS in north Wales.

Across the UK, Prostate Cancer UK has found that only half of men with suspected prostate cancer are offered the highest standards of mpMRI scans before a biopsy. The new NICE guideline, if confirmed, should change this. However, the Petitions Committee has learned that there are likely to be a number of challenges to implementing this quickly in Wales. The most obvious challenge is access to the scanners themselves.  High-quality mpMRI scans rely on MRI scanners being configured in a specific way and, generally, being less than 10 years old. Existing demand on the scanners is another potential challenge due to high demand for their use existing across a wide range of conditions. A further potential barrier is the number of radiologists, especially those with the required training to accurately report the results of scans and to use them to conclusively rule out the presence of cancer in some patients.

These are challenges that health boards and the Welsh Government are likely to need to face when the final NICE guideline is published. The Minister has stated that he expects all health boards to consider new guidance and amend their pathways of care accordingly. He has also informed the committee that he expects there to be greater consistency in service provision after the NICE guideline has been updated.

We understand that several workshops have already taken place, led by the Wales urology board, to assess the changes that will be required and to help health boards to plan for them. The Minister has also stressed that health boards do not need to wait for the final guidance to determine what local changes are needed.

The petitioner stresses that time is of the essence and that any delay in this process could cause issues in diagnosing individual patients. He is calling on the Welsh Government to ensure that the new standards are implemented rapidly and for mpMRI scans to be available across Wales as early as possible. In the meantime the petitioner has argued that the Welsh Government should fund interim arrangements, under which the NHS would pay for patients to access private scans in order to ensure that all patients who would benefit from mpMRI technology can do so.

Dirprwy Lywydd, I am sure that other Members and the Minister will wish to comment on these issues further through the remainder of the debate this afternoon. Diolch yn fawr.