Number of biopsies reduced by 32 per cent without compromising patients' safety find Swedish trials of a potentially game-changing screening programme for prostate cancer.
A new prostate cancer screening programme could significantly reduce unnecessary biopsies and better detect potentially dangerous cancer tumours compared to using the PSA blood test alone, according to the results of the STOCKHOLM-3 (S3M) trial published last night in the Lancet Oncology journal.
Currently, the standard UK clinical practice is to refer any man with a Prostate Specific Antigen (PSA) level of 3ng/ml or over to a urologist for further investigation.
But in the Swedish trial of 47,688 men aged between 50 and 69, anyone with a recording of 1ng/ml or more was put through a panel of genetic and protein biomarker blood tests that – when combined – would give a reliable indication of the presence of aggressive prostate cancer. Those that scored highly on these tests, together with those who recorded 3ng/ml or more on the original PSA test, would then be referred to a urologist for a Digital Rectal Examination and prostate volume check – only then having a biopsy if abnormalities were found.
In the end, only 4,947 of the men in the trial were biopsied – 32 per cent fewer than if the procedure had been based solely on a PSA level of 3ng/ml or more, with the instance of negative biopsies down by 44 per cent overall. Together, these results give compelling evidence that the S3M risk assessment model can dramatically reduce the number of men undergoing unnecessary biopsies, without compromising the safety of men who do have an aggressive form of prostate cancer.
But while these results are extremely promising, the men studied in Stockholm were from quite a narrow background and further research is needed to prove the tests could work with a more diverse ethnic and socio-economic population like the UK's. There are also questions about whether the NHS could justify the costs and practicalities of administering such a rigorous screening programme.
Prostate Cancer UK has been working with the trial's Swedish research team since December to come up with a plan to address these issues, with a funding scheme for research to validate the trial's findings in the UK to be announced in the next couple of months.
In the mean time, we're funding an international team of scientists to develop a risk assessment tool for use in primary care in the UK as part of our mission for better diagnosis of prostate cancer in our ambitious new research strategy.