Opinion: Prostate cancer screening ’in sight’

Professor Mark Emberton, Dean of the Faculty of Medical Sciences, writes about the new UCL-led trial, which is testing to see if MRI scans could be effective at screening men for prostate cancer, in a similar way to how mammograms are used to check women for breast cancer.

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.

Unfortunately the way we currently diagnose the disease is not very precise. Traditionally we have taken a blood test looking for raised levels of prostate-specific antigen (PSA) and carried out a trans-rectal biopsy.  But PSA levels are not a reliable indicator of prostate cancer - about 75% of men who get a positive result are not found to have cancer, while it misses the cancer in about 15% of men with prostate cancer. So we currently diagnose cancers that are harmless, leading to unnecessary operations, and we miss cancers that are harmful, leaving the disease to multiple and move around the body unchecked.  

Is imaging the answer?

The ReIMAGINE project (funded by MRC and CRUK), led by UCL and working with researchers at Imperial College, Kings College London and clinicians at UCLH is using magnetic resonance imaging (MRI), to change how prostate cancer is diagnosed and treated.

We know from international research that MRI - which has benefited from recent advances in imaging technology - can markedly and safely reduce the numbers of men needing an invasive biopsy. This research recently led to changes in NICE guidelines with MRI now recommended as the first test for men referred to hospital by their GP.

As part of ReIMAGINE we want to see if MRI could also be an effective tool for screening men, in the same way there are national NHS screening programmes to detect signs of breast or cervical cancer.

How is it being trialled?

From this month, 300 men, aged between 50 to 75 years old, will be randomly selected from London GPs and sent a letter explaining they can join the trial. Each patient will be given a PSA blood test and a 10-minute MRI scan, which is a simplified version of the 30-minute scan used in men referred to hospital because of a raised blood test. 

By combining the results of the PSA test and analysing the MRI images, radiologists and urologists, will work together to more accurately diagnose whether a man has signs of prostate cancer or not. 

Why is this important?

Capturing harmful cancer at the earliest opportunity will lead to quicker treatments, significantly better outcomes for those men affected and ultimately save lives.  It will also reduce the numbers of men undergoing biopsy, which in turn will turn reduce NHS costs and free up available time pathologists spend on analysing biopsy tissues samples.

The other important aspect of the ReIMAGINE study will be to examine whether, combined with cutting-edge techniques such as genomics and machine learning, MRI scans can replace prostate biopsies. Prostate cancer patient groups are a hugely important part of the study, and the prospect of achieving a large reduction in biopsies is an significant wish - as they have serious side effects in the majority of patients, which include pain, bleeding, infections leading to sepsis, and urine retention.

Our team aims to recruit 1,000 men with medium to high risk cancers to find out if MRI can be combined with other high-tech diagnostic tests to predict cancer progression. The ultimate aim is to develop tests that are better than biopsies for targeting the right cancer treatment to the right person - including determining if they don’t need treatment.

We are hopeful that, as a result of ReIMAGINE, we might be in a position to get rid of the biopsy and advise men on their risk based on and MRI and a blood test alone. 

Targeting and treating prostate cancer using advanced imaging is one of the most disruptive discoveries I can recall in men’s health and draws on multi-disciplinary expertise from university researchers and clinicians across the globe. By working together, we can and will continue to make significant breakthroughs in tackling cancer.

Mark Emberton is Professor of Interventional Oncology (UCL Division of Surgery and Interventional Science) and leads the ReIMAGINE consortium. 

This article was first published on the BBC website on 17 December 2019.