News, Culture & Society

Screening ALL middle-aged men for prostate cancer would pick up 8,000 extra cases

Screening all middle-aged men for prostate cancer using MRI scans would pick up 8,000 additional cases a year, a landmark trial has found.

The dramatic findings, by experts at Imperial College London, could pave the way for Britain’s first prostate screening programme.

The 15-minute scan would be used on all men between the ages of 50 and 70 to spot tumours before they become dangerous – which could save thousands of lives.

The breakthrough study, by experts at Imperial College London, could pave the way for Britain’s first prostate screening programme. (Stock image)

The breakthrough study, to be presented via video link to the world’s biggest cancer conference later this month, represents the first time any scan or test has been shown to be accurate enough for a routine prostate screening programme.

In time it could lead to a programme modelled on the breast cancer screening scheme, in which all middle-aged men would be invited for scans every five years.

The trial, which saw 411 healthy men scanned, found MRI picked up 50 per cent more aggressive cancers than using the standard ‘PSA’ blood test.

And, crucially, MRI scans were no more likely than PSA to pick up the small, insignificant tumours that doctors are worried could lead to overtreatment.

If rolled out across the UK, the team predicts that it would increase the number of aggressive cases of prostate cancer detected each year by between 7,466 and 8,350.

This would save thousands of lives – because the earlier cancer is picked up, the better the prognosis.

The researchers stress that a larger study of at least 20,000 men is needed before they can take their results to the National Screening Council – which means it would be at least six or seven years before a screening programme could be launched.

But the trial provides the first ‘proof of concept’ that MRI screening improves detection rates without leading to a boom in overtreatment.

The Daily Mail has been campaigning for more than 20 years for an improvement in prostate cancer treatments and diagnosis.

Study leader Professor Hashim Ahmed, whose results will be presented to 40,000 doctors who will log-in to the American Society of Clinical Oncology congress at the end of the month, said last night: ‘This is a massive – it will lead to a re-think about how we detect prostate cancer.

‘It has the potential to form the basis of a new screening programme for prostate cancer and could be a game-changer

‘MRI has the advantage of passing over the many cancers which don’t need to be diagnosed and focussing on the types of cancers which are more likely to shorten life.

‘By finding these aggressive cancers at the earliest opportunity, men have the opportunity to be offered less invasive treatments with fewer side effects.’

At the moment men usually only find out they have prostate cancer when they start displaying symptoms – usually when they start finding it difficult to urinate or get a hot burning sensation.

They then request a ‘PSA’ blood test from their GP – which they are eligible for over the age of 50.

But this is far from accurate – missing many aggressive cancers and picking up too many cancers that would not cause problems if they had not been detected.

Because of this PSA has never been deemed accurate enough for a screening programme.

Experts say this is the key reason that annual prostate cancer deaths are still on the rise and now kills 12,030 men in the UK a year.

On the other hand breast cancer – which has had a screening programme since Margaret Thatcher was Prime Minister – has seen deaths drop.

The NHS has started to use MRI scanners for confirming prostate cancer, but it is not yet routine, and still relies on patients having symptoms and a PSA test first.

The new trial suggests instead using MRI scanners routinely, without men ever having to undergo symptoms or a PSA test.

It would also be much quicker. The normal MRI scan takes 30 to 40 minutes, using a radioactive tracer injected into the blood stream. But for screening healthy men the tracer is not used, cutting the time to just 15 minutes.

They would, however, have to still undergo a biopsy to confirm the results if the MRI scan spots a tumour.

Professor Ahmed said: ‘If this is to be rolled out we will need major investment in scanners.

‘But we did it with mammography for breast cancer, we have done it with colonoscopies for bowel cancer, we are doing it with CT scanners for lung cancer.

‘Why should prostate be any different? We need investment if we are going to see a decline in mortality.’

Fellow researcher Dr David Eldred-Evans added: ‘We have found this is a non-invasive, safe and more acceptable way to test men for prostate cancer.

‘Unfortunately, men can often be put off from seeking medical advice when they have prostate issues because they are worried about the need for a rectal examination.

‘One of the key advantages is this it can avoid the need for rectal examination, and may encourage more men to have a prostate health check.’

Dr Mark Buzza of the men’s health charity Movember said: ‘While larger trials are necessary to validate the study and ensure its cost-effectiveness, this is a promising step towards an effective community-based screening model for prostate cancer.’

Dr Matthew Hobbs of Prostate Cancer UK said: ‘We desperately need an effective screening programme for prostate cancer to help us stop so many men dying from this disease.

‘This exciting trial shows for the first time that a screening programme which is based on MRI scans rather than blood tests might one day provide the answer we’re looking for.’ 

Questions and answers

Why are doctors so excited?

Creating a national screening programme for prostate cancer would make a major difference to men’s survival chances. Prostate cancer has become a bigger killer than breast cancer in Britain for the first time.

Why is this?

All middle-aged women are invited for mammogram scans every three years as part of the national screening programme, which is credited with saving 1,400 lives a year. 

The equivalent for prostate cancer has never been attempted before because the standard blood test – the PSA test – is unreliable.

What’s changed?

The breakthrough in MRI scanning is considered the first step to closing the diagnosis gap. Experts have shown the scans could be accurately used without men first having a PSA test, meaning any healthy man could be scanned.

What about cost?

MRI machines cost about £1million each, and not all hospitals have them. Each scan costs around £315, but experts say advances mean this will soon drop to £150 a time. And spotting prostate cancer early could save the NHS thousands of pounds per patient.