A £42 million screening trial has been launched in the UK that is set to revolutionise the treatment of prostate cancer.
Thousands of men will be involved in the first phase, which begins in a few months. Several hundred thousand volunteers could be recruited as the program progresses in the coming years, the trial organizers say.
The process, known as Transformis funded by Prostate Cancer UK with significant support from the National Institute for Health and Care Research (NIHR), Movember and several other partners, and was set up because the condition has been a persistent health problem in the UK for decades. One in eight men in the UK develop prostate cancer and around 12,000 die each year.
However, there is no screening service available to identify the early, treatable stages of the disease. Symptoms often do not appear until the cancer has spread and become incurable.
“The aim of Transform is simple,” said Dr Matthew Hobbs, the director of research for Prostate Cancer UK. “We want to find the most effective, least harmful ways to screen the UK’s adult male population for prostate cancer and detect the disease at an early stage.”
The prostate, a gland found only in men, is about the size of a walnut and produces fluid that protects the tube that carries urine and semen out of the body. When cancer develops there, it can remain there with no noticeable effect. It is only when these cancer cells spread, in some cases, to the rest of the body that they cause disease.
In the UK, more than 52,000 men are diagnosed with prostate cancer each year, around 140 a day. In total, around 490,000 men are affected by the condition.
In the past, cases were diagnosed by detecting a chemical known as prostate-specific antigen, or PSA, in a man’s blood. People with elevated levels might then be offered biopsies, in which tissue is removed from the prostate by inserting a needle into the rectum.
“The problem is that a high PSA level in the blood does not necessarily mean that a man has prostate cancer,” Hobbs added. “Also, cancer cells in a prostate do not necessarily spread throughout the body in any case. They can remain dormant.
“This means that biopsies are sometimes performed unnecessarily, which is a problem because they can be painful and sometimes lead to infections and occasionally sepsis.”
As a result, the UK’s National Screening Committee, which advises the government on health screening programmes, has refused to give the green light for a national prostate cancer programme, saying it would do more harm than good.
“That needs to change,” said Prof Hashim Ahmed of Imperial College London. “We need to be in the position we are in with breast and cervical cancer where a woman is invited by her GP for a mammogram or a smear test. Prostate cancer testing, on the other hand, is irregular, infrequent and unsystematic.”
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The aim of Transform – one of the largest medical research studies to be launched in the UK in recent years, with £16 million of government funding – is to rectify this by finding better ways to detect prostate cancer.
Newly developed techniques, such as MRI scans that can detect affected prostates rather than relying solely on PSA tests to determine who should and should not be biopsied, will be tested as an alternative to biopsies. In addition, new genetic tests will be used to highlight those who may be at increased risk of developing the condition due to inherited susceptibilities.
“There is no major gene that puts a man at a much higher risk of prostate cancer, but there are about 400 that, in combination, increase the chance that men will get it,” Hobbs said. “We can use this panel of genes to test whether they can identify those who are at high risk. This could then be part of future screening programs.”
Another challenge for those tackling the condition is the response of those most at risk for the disease. Black men are twice as likely to develop prostate cancer, but are far less likely to come forward for testing. In trials to determine whether a national screening program was viable, black men were far less likely than white men to respond to requests to sign up.
“That’s a very worrying statistic and we urgently need to address it,” said Prof Caroline Moore, head of urology at University College London. Her team will this year launch a “scan-in-a-van” service at a site in west London, offering MRI scans in a mobile centre to black men aged 45 and over to test for possible signs of prostate cancer.
“Rather than through GPs, we will be approaching them through local community groups,” she said. “Hopefully, in the future, community scanning programmes can be incorporated into prostate screening programmes. It will be another part of the package, we hope.”