Behind the headlines: could MRI screening become a reality for men?

Several newspapers today are reporting on an upcoming trial, called RE-IMAGINE, which looks at whether MRI scans could be used as a screening tool for prostate cancer. That is, offered to all men over a certain age as part of a national screening programme. The headlines talk of a ‘ten-minute test’ which could give men the ‘all clear for life’.

There’s a reason this kind of research is headline-grabbing: there’s currently no screening programme for prostate cancer, as the tests we have aren't reliable enough at spotting prostate cancer. Better tests and scans could help bring us closer to a screening programme, to make sure all men’s prostate cancers are caught early enough while it’s still possible to cure.

A focus on feasibility

This research is still in the early stages, and so the main aim of RE-IMAGINE is to see if first-line MRI screening is feasible, rather than if it is an effective screening tool.

This means checking that enough men are willing to have the scan, before further research is done to see if MRI could be part of an effective screening programme. The trial will invite 350 men at random for scanning, measure if enough men accept the invitation, and test the best way to contact them.

The team are using a type of MRI scan called bi-parametric (bp) MRI. This is similar to multiparametric (mp) MRI, which is already being used in diagnosis, but doesn’t require an injected dye, meaning that it can be done more quickly and cheaply. The hope is that bpMRI could be more feasible than mpMRI as an initial test for a screening programme.

Even though it’s faster than mpMRI, each bpMRI scan still takes 15–20 minutes, and so the promise of a '10-minute scan' would need further improvements in imaging technology. It’s also likely that mpMRI would still be important to confirm a prostate cancer diagnosis after this first triaging process, or to monitor the progression of prostate cancer.

Once in a lifetime?

Once we know if this approach is feasible, we’ll need further research to see if it accurately spots prostate cancers that require treatment, and how often men would need to be scanned.

For some cancers, like colorectal cancer, one-time screening can be effective. In contrast, breast cancer screening is done every three years. The researchers expect that as prostate cancer can be slow growing, scans every 10 years (or even once in a lifetime) could be sufficient. However, we don’t yet know enough about how and why prostate cancer develops to be sure.

Screening on the horizon

Any research that’s a step towards our ambition for a national screening programme, and enables men to get an early prostate cancer diagnosis, is certainly exciting. MRI could be an easy and effective way to check for prostate cancer, however, there is still lots we don’t know about the best way to do this.

We’ll need to look at MRI screening in many more men, in large randomised trials, before we can know if it could be an effective way to screen for prostate cancer. It’s also possible that an imaging-based programme is not the only answer. For example, a blood test may be cheaper and easier for the NHS to roll out, as it wouldn’t require investment in scanners and specialised radiologists.

Research like this might take another 10–15 years, but we will be following the results closely, ready to support and campaign for whatever approach will help us bring men the screening programme for prostate cancer they deserve.