A national prostate cancer screening programme in the UK could prevent one in six deaths from the disease, new research claims.
Scientists at University College London (UCL) are proposing ‘more targeted’ check-ups for those at higher risk of the disease based on their age and genetic profile.
Results of their modelling study suggest a programme that first involves taking samples of the blood or saliva in the search for genetic ‘biomarkers’ could prevent up to 16 per cent of prostate cancer deaths.
Unlike for breast and cervical cancer, in the UK, there is no national screening programme for prostate cancer, because until now, it has not been proved that the benefits would outweigh the risks.
Prostate cancer is the most common form of cancer in men with around 130 new cases diagnosed in the UK every day and more than 10,000 men a year dying as a result of the disease.
Researchers at University College London (UCL) are proposing ‘more targeted’ check-ups for those at higher risk of the disease based on their age and genetic profile. Pictured, prostate cancer cells (stock image)
‘Prostate cancer is a leading cause of death from cancer amongst men, but there is no screening programme because the harms of screening are considered to outweigh the benefits,’ said study author Dr Tom Callender at UCL.
‘However those at higher genetic risk are more likely to benefit from screening and less likely to be harmed.’
Currently, men suspected of having prostate cancer can opt for a prostate specific antigen (PSA) test, which requires a blood sample.
The PSA test was previously the only test men would have to detect the presence of prostate cancer.
But PSA ‘is not perfect’, as the NHS puts it, and does not accurately distinguish between dangerous cancers and harmless ones.
This can lead to problems of under-diagnosis, meaning aggressive life-threatening cancers are missed, and over-diagnosis, leading to both unnecessary operations and missed cancers that are harmful.
At present, some 12,000 men die each year from prostate cancer – compared to around 11,000 for breast cancer – and over the course of the last decade the number of deaths has overtaken that of breast cancer.
While breast cancer screening is routinely offered to women from 50 years, there is no equivalent screening programme for prostate cancer.
As of 2019, National Institute of Clinical Excellence (NICE) guidelines advise all men with a positive PSA result have an MRI scan (which uses strong magnetic fields and radio waves to produce detailed images of the inside of the body) before a biopsy.
A biopsy, which is an invasive procedure, uses thin needles to take small samples of tissue from the prostate.
This extra step of having an MRI scan has been shown to better distinguish and increase detection of aggressive cancers whilst reducing over-diagnosis and unnecessary treatment of insignificant cancers.
Prostate cancer is the most common form of cancer in men with around 130 new cases diagnosed in the UK every day and more than 10,000 men a year dying as a result of the disease. However, unlike breast and cervical cancer there is currently no national screening programme for this disease in the UK (stock image)
Building on this, researchers say recently discovered genetic markers that predict prostate cancer risk – known as a polygenic risk score – could also complement a PSA test and MRI scan.
This polygenic test, which is not yet widely available, uses a sample of blood or saliva from the mouth to assess the numerous genetic variants.
It can identify individuals with high-risk prostate cancer genes (biomarkers) and help predict when an individual is likely to start to benefit from screening.
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For their study, researchers created a hypothetical cohort of 4.5 million men, representing the number of men aged 55 to 69 in England.
They simulated the health outcomes of introducing two potential screening programmes into this population – age-based and risk-tailored.
An age-based screening programme would see all men aged between 55 and 69 receive a PSA test every four years, and if the test was positive this would be followed by MRI and, if required, a biopsy.
Meanwhile, the risk-tailored pathway would see men screened if their risk – determined by both their age and polygenic risk score – reached a certain threshold.
The models revealed that the scenario generating the most benefits would be to screen men with a 3.5 per cent risk of getting prostate cancer over the next 10 years – roughly half of all men aged 55 to 69, the researchers found.
Such a programme could prevent up to 16 per cent of prostate cancer deaths – about one in six – and reduce overdiagnosis by 27 per cent.
Screening men at this threshold (3.5 per cent) would also be more cost-effective than screening all men aged 55 to 69.
‘Screening for prostate cancer – which could save between 16 per cent and 20 per cent of prostate cancer deaths – might be possible with targeted screening using genetic risk and MRI as part of the diagnostic pathway,’ said study co-author, Professor Mark Emberton at UCL.
‘This paves the way for further clinical trials to study the real-world implementation of such a screening programme.’
The study has been published in JAMA Network Open.
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