A £42 million screening trial that aims to revolutionize the treatment of prostate cancer was introduced in the United Kingdom.
Thousands of men will be involved in the initial phase, which will begin in a few months. Several hundred thousand volunteers could be recruited as the program progresses in the coming years, the trial’s organizers say.
The trial, known as Transformwas funded by Prostate Cancer UK with significant support from the National Institute for Health and Care Research (NIHR), Movember and various other partners, and was set up because the condition remained an intractable health problem in the UK for decades. One in eight men get prostate cancer in the UK and around 12,000 die each year.
Yet there is no screening service available to detect the disease’s early, treatable stages. Symptoms often do not appear until the cancer has spread and become incurable.
“The aim of Transform is simple,” says Dr Matthew Hobbs, the director of research for prostate Cancer UK. “We want to find the most effective, least harmful methods to screen the UK’s adult male population for prostate cancer and catch the disease in its early stages.”
The prostate, a gland found only in men, is the size of a walnut and makes fluid that protects the tube that carries urine and sperm out of the body. When cancers develop there, they may remain without noticeable effect. It is only when these cancer cells, in some cases, spread 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, approximately 490,000 men are affected by the condition.
In the past, cases were determined by detecting a chemical known as prostate-specific antigen, or PSA, in a man’s blood. Those with elevated levels may then be offered biopsies in which tissue is removed from the prostate by inserting a needle through the rectum.
“The problem is that a high level of PSA in the blood does not necessarily mean that a man has prostate cancer,” Hobbs added. “Furthermore, cancer cells in a prostate do not necessarily spread throughout the body in every case. They can remain dormant.
“This means that biopsies can sometimes be performed unnecessarily, which is a problem because they can be painful and sometimes lead to infections and sometimes sepsis.”
As a result, the UK National Screening Committee, which advises the government on health screening programmes, has refused to give the go-ahead for a national prostate program on the grounds that it would do more harm than good.
“It has to change,” said Prof Hashim Ahmed of Imperial College London. “We have to be in the position of being with breast and cervical cancer when a woman is invited by her family doctor to have a mammogram or a cervical smear. In contrast, prostate cancer testing is irregular, patchy and unsystematic.”
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This is the aim of Transform – one of the largest medical research trials to be launched in the UK in recent years and whose funding includes £16m from the Government – to fix this by identifying better ways to treat prostate cancer to investigate.
Newly developed techniques, such as MRI scans that can spot affected prostates instead of relying solely on PSA tests to determine who to biopsy or not, will be tested as alternatives to biopsy. In addition, new gene tests will be used to highlight those at increased risk of developing the condition due to inherited susceptibility.
“There is no one major gene that puts a man at much greater risk for prostate cancer, but there are about 400 that, in combination, increase the chances of a man being affected,” Hobbs said. “We can use this panel of genes to test to see if they can identify those who are at high risk. This can then form part of future screening programs.”
Another problem for those tackling the condition is the response of those most at risk of the disease. Black men are twice as likely to get prostate cancer, but are much less likely to come forward for testing. In trials to determine whether a national screening program was viable, black men were much less likely than white men to respond to requests to report.
“This is a very worrying statistic and we urgently need to tackle this problem,” said Prof Caroline Moore, the head of urology at University College London. This year, her team will launch a “scan-in-a-van” service at a site in west London, where MRI scans will be offered in a mobile center to black men over 45 to test for possible signs of prostate cancer.
“Instead of going through GPs, we will contact them through local community groups,” she said. “Hopefully community screening schemes can be incorporated into prostate screening programs in the future. It will be another part of the package, we hope.”
