Targeted prostate cancer screening would prevent deaths

Friday March 12th 2021

A targeted screening programme for men who are genetically pre-disposed to prostate cancer could prevent one in six deaths from the disease and significantly reduce over-diagnosis, a new UK study has found.

A modelling study, led by UCL with researchers from the University of Cambridge, created a hypothetical cohort of 4.5 million men, representing the number of men aged 55 to 69 in England, and simulated the health outcomes of introducing either age-based and risk-tailored screening programmes.

The work follows the UCL-led PRECISION trial, which resulted in NICE advising all men with a positive PSA result should have an MRI scan prior to biopsy because this better distinguishes and increases detection of aggressive cancers while reducing over-diagnosis and unnecessary treatment of insignificant cancers.

The researchers add recently discovered genetic markers that predict prostate cancer risk could also complement a PSA test and MRI scan. A polygenic test, which is not yet widely available, can identify individuals with biomarkers and help predict when an individual is likely to start to benefit from screening.

Writing in JAMA Open Network, the researchers describe how the age-based diagnostic pathway modelled a screening programme in which all men aged between 55 and 69 would receive a PSA test every four years. If the test was positive, they would go on to have an MRI and, if required, a biopsy.

The risk-tailored pathway modelled a screening programme in which men would get a PSA test, followed by MRI and biopsy if required, if and when their risk – determined by their age and polygenic risk score – reached a certain threshold.

They found the most beneficial option would be to screen men with a 3.5% risk of getting prostate cancer over the next 10 years, which equates to about half of all men aged 55 to 69.

This could prevent up to 16% of prostate cancer deaths and reduce over-diagnosis by 27%. Screening men at the 3.5% threshold would also be more cost-effective than screening all men aged 55 to 69, conclude the researchers.

Using the age-based screening pathway would result in about 20% of prostate cancer deaths being prevented, but the researchers say targeted risk-based screening prevents a similar number of deaths while reducing the number of over-diagnosed cancers and the number of biopsies needed by approximately one third.

Senior author Professor Nora Pashayan, of UCL Applied Health Research, said: “In men with a positive screening blood test, we found that using an individual’s genetic profile alongside a diagnostic pathway that uses MRI scanning before biopsy, could reduce unnecessary diagnoses whilst preventing deaths from prostate cancer by detecting the cancers at an early, curable stage.”

Co-author Professor Mark Emberton, UCL Dean of the Faculty of Medical Sciences, said the study paves the way for further clinical trials to study the real-world implementation of screening programmes.

Callender T, Emberton M, Morris S et al. The impact of MRI prior to biopsy on age-based and risk-tailored screening for prostate cancer: A benefit-harm and cost-effectiveness analysis. JAMA Network Open. 11 March 2021; doi: 10.1001/jamanetworkopen.2020.37657

Tags: Cancer | Genetics | Men's Health | UK News

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