In a first-of-its-kind study, researchers at University College London (UCL) have conducted a clinical trial to use MRI scans with PSA (prostate specific antigen) to aid in prostate cancer screening and assess the need for additional testing. The research, published in BMJ Oncology, showed that of the 29 participants in the study found to have serious prostate cancer, 15 of them had a low PSA score that would have meant they were not referred for additional testing under current guidelines of the UK’s National Health Service (NHS).
The hope for developing more accurate prostate cancer screening is to reduce the need for invasive biopsies, which can produce complications from the procedure, as well as reduce prostate cancer mortality and overtreatment.
The new study included 303 men 50 to 75 years of age and provided them with a screening MRI and PSA test. Of those tested, 48 (16%) had a positive screening MRI that indicated there might be cancer, despite only having a median PSA density result of 1.2 ng/ml1. 32 of these men had lower PSA levels than the current screening benchmark of 3ng/ml. meaning they would not have been referred for further investigation by the PSA test currently in use.
Further assessment determined that 29 or the men had cancer that required treatment, 15 of them had serious cancer and a PSA of less than 3ng/ml, meaning they would not have been referred for further investigation by the PSA test currently in use.
“The thought that over half the men with clinically significant cancer had a PSA less than 3 ng/ml and would have been reassured that they didn’t have cancer by a PSA test alone is a sobering one and reiterates the need to consider a new approach to prostate cancer screening,” says Caroline Moore a UCL Surgical & Interventional Science and consultant surgeon at UCLH), chief investigator of the study and NIHR Research Professor, said: Our results give an early indication that MRI could offer a more reliable method of detecting potentially serious cancers early, with the added benefit that less than one per cent of participants were ‘over-diagnosed’ with low-risk disease. More studies in larger groups are needed to assess this further.”
The researchers noted that Black men responded to the invitation for prostate cancer screening at one-fifth the rate as white men, and issue they say will need to be addressed considering the heightened risk Black men have of developing the disease.
“One in four black men will get prostate cancer during their lifetime, which is double the number of men from other ethnicities,” notes UCL’s Saran Green an author of the study. “Given this elevated risk, and the fact that black men were five times less likely to sign up…than white men, it will be crucial that any national screening program includes strategies to reach black men and encourage more of them to come forward for testing.”
Next steps toward using the data from the recent trial to develop a national prostate screening program in the UK are already in motion. The new LIMIT clinical trial will include a significantly larger number of patients, with an special efforts being launched to get more Black men to participate. One such program includes mobile ‘scan in a van’ initiatives that will bring the screening procedures into communities where people are less likely to respond to an invitation from their doctor. Pending results of the LIMIT trial, a nationwide trial will then be conducted before requiring this method as standard practice in clinics.
“The UK prostate cancer mortality rate is twice as high as in countries like the US or Spain because our levels of testing are much lower than other countries. Given how treatable prostate cancer is when caught early, I’m confident that a national screening program will reduce the UK’s prostate cancer mortality rate significantly,” concludes Mark Emberton, a professor at UCL Surgical & Interventional Science and the study’s senior author.
