After a UCL-backed collaborative research study, NICE guidance has been updated to outline that all men with a positive PSA (prostate-specific antigen) result should have an MRI scan prior to biopsy.
The advice is directed at men who show signs of suspected prostate cancer or have a blood test that detects raised levels of the prostate-specific antigen.
From UCL’s Division of Medicine, Dr Tom Callender, lead author of the research, said: “Prostate cancer is a leading cause of death from cancer amongst men, but there is no screening programme because the harms of screening are considered to outweigh the benefits.
“For this benefit-harm and cost-effectiveness analysis, we asked how effective a four-yearly PSA screening for all men aged 55 to 69 would be, versus more targeted checks for those at higher risk of the disease based on their age and genetic profile.”
In the modelling study, a hypothetical sample size of 4.5 million men was created to reflect the population of men in England who are aged 55 to 69 in England and most at risk of prostate cancer. It also used a simulation to predict the health outcomes in using “age based” screen and “risk tailored” screening.
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, and if the test was positive this would be followed by MRI and, if required, a biopsy.
The results of the study were encouraging and concluded it would be to beneficial to screen men with a 3.5% risk of getting prostate cancer over the next 10 years – that is, roughly half of all men aged 55 to 69. Such a programmed could prevent up to 16% of prostate cancer deaths.
Co-author, Professor Mark Emberton, UCL Dean of the Faculty of Medical Sciences: “Our study shows that screening for prostate cancer – which could save between 16% and 20% of prostate cancer deaths – might be possible with targeted screening using genetic risk and MRI as part of the diagnostic pathway. This paves the way for further clinical trials to study the real-world implementation of such a screening programme.”
