A UK trial where men who had no symptoms were screened for prostate cancer found hundreds had life-threatening forms of the disease which might otherwise not have been spotted in time, Good Health can reveal.
If the trial, which was confined to two counties in England, had been extended to the whole country, ‘thousands more’ men with prostate cancer who might otherwise die of the disease could potentially have been detected, says Stephen Langley, a professor of urology at the Royal Surrey County Hospital, Guildford, and co-chairman in urology of the Surrey & Sussex Cancer Alliance – which led the study.
Professor Langley says he’s ‘very hopeful’ the results, which show that targeted screening is effective, will add to the case for a nationwide programme aimed at men whose age or family history puts them at higher risk of the disease.
Prostate cancer is now the most common cancer in England, with 55,000 new cases diagnosed each year. It is responsible for 12,000 deaths annually, but there is no screening for it even though it’s usually symptomless in early stages.
Currently 45 per cent of prostate cancer cases are diagnosed at a late stage when it is harder to treat and may have spread. By comparison in breast cancer – which women are screened for from the age of 50 – 26.9 per cent of cases are spotted at this later stage, according to Cancer Research UK figures.
For the new study, 18,000 men without any symptoms of prostate cancer were first given a blood test to check levels of prostate-specific antigen (PSA), a protein made by the prostate – raised levels can be a sign of cancer.
Men were contacted by text having been selected from the database of 50 GP surgeries in the Surrey and Sussex area.
They were directed to a website which invited them for a blood test conducted by Medefer, an online healthcare company.
The men included were aged 50-70, black men aged 45-70 (who have almost double the risk of prostate cancer) or those whose family history of cancer put them at risk (as well as prostate cancer, this includes having female relatives with a history of breast cancer related to BRCA gene mutations).
The men were advised to avoid sex or strenuous lifting for three days beforehand, both of which can raise PSA, and were given a urine test to check for infection, which can also cause PSA levels to rise.
Just under 5 per cent (4.7 per cent or 865 men) were found to have a raised PSA (generally speaking, either over 3ng/ml or depending on age from 2.5ng/ml to 6.5ng/ml) – they were then sent for an MRI scan for detailed images of the prostate: 343 of these men were then referred for a biopsy and 64 per cent of them (221 men in total or 1.2 per cent of the total tested) were found to have ‘life-threatening’ forms of the disease.
‘And this is among men who have no symptoms,’ says Professor Langley, who presented the results of the Targeted Prostate Health Check, which is the first NHS-funded targeted screening programme to be tried in this country, at the European Urology Association meeting in Madrid last week. The results have now been submitted for publication in a journal.
He believes the approach used in the 18-month trial could easily be rolled out throughout the UK, with these targeted men re-tested every two to three years and with blood tests performed at GP surgeries or via mobile vans.
The decision about whether to adopt screening nationwide falls to the UK National Screening Committee, which has previously rejected it due to the inaccuracy of PSA as a measure, but it is reviewing this, and is due to report later this year.
PSA may give rise to false positives and lead to the ‘over-diagnosis’ of cancers that may not prove a major threat to health.
‘There are many reasons PSA can be raised – simply having a bigger prostate can push up the levels, yet previously every man who had a raised PSA would be sent for biopsy [which can be uncomfortable and carries a risk of infection] and we were finding what may be insignificant cancers that would not be a major threat,’ says Professor Langley.
‘But the MRI is the real gamechanger in this programme. It can help us determine who really does need a biopsy and who doesn’t,’ he adds. He believes the targeted screening approach ‘could help save many men’s lives and I believe would end up being cheaper than treating late-stage prostate cancer as we currently do’.
Being selected to take part in the trial was life-saving for retired engineer Richard Flashman, 68, as in December 2022 it revealed he had an aggressive form of prostate cancer.
‘It’s a real shock to be told you have cancer when you don’t feel unwell,’ says Richard, a father of three, who lives with wife Caroline, 68, a retired solicitor, in Guildford, Surrey. ‘I felt so fit and healthy and was leading an active, outdoor life.’
After getting a call to say his PSA at 3.8 warranted an MRI, to Richard’s utter shock this revealed he had two tumours in his prostate. A biopsy graded his cancer as a 9 (out of a possible 10) on the Gleason score which rates a cancer’s aggression and likelihood to spread.
He opted for radiotherapy and hormone treatment rather than risk side-effects such as impotence, which can follow surgery to remove the prostate.
He says: ‘I’m fine now and all my functions are settling back to normal after the treatment. But if it wasn’t for screening there’s every chance that the cancer would have spread and would have been untreatable by the time I got symptoms.’
Amy Rylance, assistant director of health improvement at Prostate Cancer UK, said the results of the new trial ‘are very encouraging – both that large numbers of men came forward for screening and that the project successfully identified hundreds of life-threatening cancers in time for a cure’.
Tim Dudderidge, a consultant urological surgeon based in Southampton, also welcomed the results. ‘Broadly, I do think screening done with an MRI being the triage for a biopsy identifies lethal cancers without excessively diagnosing the ones we don’t really need to know about,’ he says. But he adds: ‘The National Screening Committee has well-developed scientific thresholds for developing screening and they believe we need another trial to determine the best approach.’
