Accuracy And Equity In Prostate Cancer Diagnosis

A game-changing prostate cancer diagnostic pathway project is fully scoped and ready to begin at the Mātai Medical Research Institute (Mātai) in Tairāwhiti Gisborne as soon as funding is secured.

The project, a New Zealand first titled Accuracy and Equity in Prostate Cancer Diagnosis, will be led by the Clinical Lead at Mātai, Dr Daniel Cornfeld, and is aimed at vastly improving this country’s current diagnostic pathway in prostate cancer for patients in the public health system, particularly for those who live in under-served and remote communities.

Dr Cornfeld, previously Chief of Abdominal MRI at Yale-New Haven Hospital and Associate Professor of Radiology at the Yale University School of Medicine, works adjunctly as Chief Radiologist at Hauora Tairāwhiti, Gisborne’s public hospital, and says the project will chart the efficacy in New Zealand of a model of care approach for patients using the latest evidence-based methods already adopted in prostate cancer diagnostic pathways in the United States, the United Kingdom and Europe.

Dr Cornfeld says “At Mātai, our goal is to be at the forefront of change to impact the future health of all New Zealanders, no matter where you’re from or where you live. Because we are based in Tairāwhiti Gisborne, we have a unique opportunity to provide a relatively remote community with access to world-class medical care. 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 pathway parallels those in use in countries such as the UK and the US.”

The Mātai pathway will initially be validated with patients in the Tairāwhiti Gisborne region, and will draw upon the power of the pioneering magnetic resonance imaging (MRI) scanning technology and software at Mātai, and leverage the local and international expertise that forms the cornerstone of the recently established research centre.

The project is a collaboration between Mātai, primary care, and community health groups. Mātai has assembled 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 Māori men as participants in the study; Māori make up approximately 40 percent of the male population in the Tairāwhiti Gisborne region. Study participants will be selected and counselled through a newly introduced prostate cancer outreach and education programme.

The Mātai state-of-the-art GE Healthcare 3T MRI scanner, located in Tairāwhiti, 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. Knowing this can make it easier for someone to decide to undergo screening. Targeted biopsy has also been shown in multiple international studies to be superior to the standard, non-targeted, biopsy in that it identifies more cancers requiring treatment and fewer ones that do not.

Mātai and GE healthcare scientists have collaboratively pushed the limits of their advanced MRI scanner to develop a 10 to 15-minute MRI prostate cancer scan protocol that will be used in this study. This will greatly reduce the current standard scan time in New Zealand of approximately 45 minutes. A shorter scan time means more scans can be performed; which potentially increases access to MRI.

Dr Cornfeld says “There is currently no prostate cancer screening programme in New Zealand. Ultimately, the goal of our optimised diagnostic pathway is to improve screening in our most vulnerable populations, identify more treatable cancers in younger patients, and eventually decrease the number of older men presenting with incurable disease. This project will increase the number of patients evaluated with MRI and use this information to tailor treatment to the patient.

“In time, we would like to scale this pathway to larger regions and have it recognised as the new national standard for prostate cancer diagnosis in New Zealand.”

Peter Dickens, Chief Executive of the Prostate Cancer Foundation of NZ says “The Accuracy and Equity in Prostate Cancer Diagnosis project is an enormously exciting and important initiative with the potential to be significantly influential in bringing Aotearoa New Zealand into line with best diagnostic practice globally . It’s exciting also 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. We commend the Mātai team for this initiative and look forward to working with them as their plans progress.”

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Dr Cornfeld – formerly the Chief of Abdominal MRI and Associate Professor of Radiology at Yale University – has considerable experience in testing new scanning/imaging tools, and in evaluating these new scanning technologies for clinical application. He is an expert in interpreting MRI scans of the prostate, and has previously set up a similar MRI-prior-to-targeted-biopsy pathway at Yale-New Haven Hospital in the United States. He currently also serves as head of department for Radiology at Hauora Tairāwhiti and is well positioned to facilitate clinical collaborations between the community and Mātai.

Dr Cornfeld will work on this project closely with two key co-investigators, Mr Michael Rice and Ms Leigh Potter (Ngāti Porou; Ngāti Kahungungu, Rongowhakaata, Rongomaiwahine).

Mr Rice is a consultant urologist based at Auckland City Hospital, and is established as the visiting urologist to Hauora Tairāwhiti. He will function as the clinical urologist overseeing the care of patients in this study and provide visiting consultant prostate services for Mātai. Mr Rice, who has an interest in clinical research, will work closely with Dr Cornfeld to streamline prostate assessment in Tairāwhiti and help to modify clinical practice locally to guide equity in prostate cancer services.

Ms Potter is the Chief Operations Officer at Mātai, and will lead her team to assist with operationalising the project.

Ms Potter will also lead the critical engagement with local iwi to participate in the research, and will mentor Māori GPs and Māori/Pacific students involved in the various research workstreams within the study.

About Mātai

Mātai is a non-profit medical imaging research and innovation centre, based in Tairāwhiti Gisborne, New Zealand. Mātai aims to enhance the capabilities of Magnetic Resonance Imaging (MRI) through research and development into advanced medical imaging software and machine learning.

The Mātai team is led by founder Dr Samantha Holdsworth, Mātai Research Director, Senior Lecturer at the University of Auckland and Principal Investigator at the Centre for Brain Research. Dr Holdsworth is a leading expert in human brain imaging and a pioneer of super-fast, high resolution MRI methods and amplified MRI (aMRI), a new method of visualising brain motion. Her work has included the development of new MRI methodologies to help diagnose disease earlier. Matai has a collaborative national and global network of 32 affiliate faculty advisors and 37 medical research, scientific, and engineering advisors. These include world leaders in their respective fields across various disciplines, who are committed to collaborating across a range of medical research projects.

MRI is unsurpassed in its capabilities to transform our understanding of health. It is safe, non-invasive, and can reduce the need for unnecessary invasive surgeries. Advances in medical imaging, which include scan clarity and shortening scan time, have the potential to redefine the way we identify disease and disorders, enable earlier interventions and treatments, and new ways of managing health disorders.

The establishment of Mātai was made possible through PGF seed funding administered by Kānoa – Regional Economic Development & Investment Unit, , with additional support from Trust Tairāwhiti, the University of Auckland, the JN Williams Memorial Trust and the HB Williams Turanga Trust, Pultron Composites, the Dame Bronwen Holdsworth and Dr Peter Holdsworth Trust and many others.

Dr Dan Cornfeld

Clinical Lead at Mātai

Chief Radiologist, Hauora Tairāwhiti

Dr Cornfeld, previously Chief of Abdominal MRI at Yale-New Haven Hospital and Associate Professor of Radiology at the Yale University School of Medicine. He has considerable experience in testing new imaging tools, experiment design, and in evaluating new imaging technologies. Dr Cornfeld is a contributor to the PIRADSv2 document (an international consensus document describing how MRI should be used in the diagnosis and treatment of prostate cancer); has 15 years’ experience performing and interpreting prostate MRI; and has facilitated in establishing a similar prostate diagnostic pathway at Yale-New Haven Hospital in the United States. He currently also serves as head of department for Radiology at Hauora Tairawhiti and is well positioned to facilitate clinical collaborations between the community and Mātai.

Ms Leigh Potter, Ngāti Porou; Ngāti Kahungungu, Rongowhakaata, Rongomaiwahine (Te Mahia)

Chief Operations Officer at Mātai

Leigh Potter is one of only a few Māori medical imaging technologists. Ms Potter has significant medical imaging, project management and leadership experience, and is passionate about improving health outcomes in Māori and underserved populations. She is supporting and helping to guide the innovative research programmes in place at Mātai which will have strong translation into clinical practice for improving patient outcomes. In her role as a member of the Malaghan Māori Advisory Group, the National Radiology Advisory Group (NRAG), and Ngā Māngai Māori at the Mātai Medical Research Institute, Ms Potter is working closely with research teams and NRAG to improve engagement with Māori and address inequalities in health. She is also a mentor to Māori staff and researchers on a recently-awarded Marsden project grant on a novel non-invasive tool for measuring brain pressure in various pathologies. As a descendent of Ngāti Porou, Rongomaiwahine, Rongowhakaata, and Ngāti Kahungungu. Ms Potter has been involved in school workshops to promote Medical Imaging to students at high schools in Gisborne, in particular Māori students. She developed a research proposal which looked at strategies to help in the recruitment of more Māori or other ethnic minorities into the Medical Imaging field. The proposal was presented to UNITEC and other organisations. Ms Potter’s involvement in Mātai research programmes is enabling Mātai to effectively design and manage research proposals for Māori that encourage participation by Māori, which will result in improvements in Māori health outcomes.

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