UK trial brings together four prostate cancer screening approaches

The first men have been recruited for a screening trial which aims to find a better way to detect prostate cancer.

There is no nationwide screening program in the UK for prostate cancer. The most common test, a prostate-specific antigen (PSA) blood test, is offered to men over 50, but misses some dangerous cancers and detects too many harmless ones. The new trial will evaluate PSA tests, alongside – or in combination with – a polygenic risk test derived from a saliva sample and a rapid MRI scan known as a prostagram.

'It's wonderful to see the trial launch today – it brings us one step closer to ensuring prostate cancer diagnosis is safe, effective, and equitable for all men,' said co-leader Professor Ros Eeles from the Institute of Cancer Research (ICR), London.

According to ICR figures, a PSA test alone returns false positives in three out of four cases, leading to unnecessary MRI scans and biopsies. Where tumours are present, surgery can have serious side effects, including incontinence and impotence, meaning that it is important to not only detect the presence of cancer, but to accurately assess how much of a risk it presents.

The 'Trial of Randomised Approaches for National Screening for Men' (TRANSFORM) will recruit 16,000 participants in the first stage, and will compare new screening techniques with existing NHS diagnostics. Further expansion of the trial will include 300,000 men to test the most promising strategies identified from the initial stage, making it the biggest prostate cancer screening trial in decades.

Findings from a previous study indicated that polygenic risk scores based on risk-associated genetic variants were more accurate in identifying prostate cancer than the standard PSA test in men aged 55-69 years old (see BioNews 1285). The polygenic risk score was developed using large-scale datasets to identify 130 variants associated with prostate cancer, and then combining the data to identify men with the highest abundance of these variants.

'Prostate cancer is one of the biggest killers of men in the UK. Devastatingly, around one in eight will get it, and that risk is doubled in black men,' said Health and Social Care Secretary Wes Streeting.

As part of the TRANSFORM programme, biological samples from the trial will be integrated to create a resource to assist research into the discovery of new clinical biomarkers and enable improved accuracy of prostate cancer screening and early detection.

The trial launches just as the UK National Screening Committee is due to announce its decision on whether to introduce screening for the disease. Results of the first phase are expected in around two years.