Professor Gordon Wishart shares an update on prostate screening:

Evidence

• The European Randomised Study of Prostate Cancer (ERSPC) Screening has shown in a randomised trial that PSA testing results in at least a 21% reduction in deaths from the disease at 10-12 years after randomisation.
• Main resistance to implementation of a UK national screening programme has been the number of unnecessary biopsies, and their resultant side effects (pain, infection, impotence)
  
• The PROMIS trial (2017) showed that when used as a triage test prior to prostate biopsy, the use of multi-parametric MRI (MP-MRI) can reduce the number of unnecessary biopsies by 25% and increase the diagnosis of clinically significant cancer. 
  
• The PRECISION Trial (2018) showed that 28% of men randomised to MRI-targeted biopsy avoided prostate biopsy altogether while detecting 12% more clinically significant cancers than in the standard TRUS biopsy.

Problems

• Five years have passed since the PROMIS study was published, and still, no national UK screening programme has been introduced.
• Men over the age of 50 can request a PSA test from their GP, but access to GP testing has reduced post lockdown.

Future

• There are currently 12000 deaths a year in the UK from prostate cancer
• In 2025, Prostate Cancer UK will launch the TRANSFORM trial to look for the most accurate and cost-effective way to screen men for prostate cancer
• Men aged 50-75, or 45-75 for black men, will be invited to participate in the trial
• Four new approaches will be tested, including fast MRI scans (12 minutes), genetic testing & PSA testing
  
• Early results will not be available until 2028 at the earliest

Conclusion

• We should continue with PSA testing, followed by prostate MRI scans for men with raised PSA to determine who requires a targeted biopsy.
• Check4Cancer is exploring the launch of a salivary DNA test to identify men at a significant risk of prostate cancer (top 10%) based on the BARCODE 1 study results that showed that this high-risk group have a high proportion of significant prostate cancer that requires treatment.