In the most recent Newsletter from Prostate Cancer Research (PCR) (pictured) they cover a report in which they look at the crucial issue of over diagnosis and over treatment - a huge issue - their argument is that with improvements in MRI (mpMRI) and guided transperineal biopsies the picture is very different. There is also more acceptance of active surveillance rather than going straight to invasive treatments.
We know the current situation does not work: "The existing “informed choice” system for requesting testing places the onus on men to understand their risk and actively seek testing. This system is both ineffective and inefficient and contributes to the fact that men from high-risk groups, particularly Black men, are more likely to be diagnosed late and are more than twice as likely to die from this disease."
Deloitte's were commissioned to look at a cost-benefit analysis for change. This indicates that the introduction of a targeted national prostate cancer screening programme for high-risk groups using the current pathway could deliver:
• Around 650 earlier diagnoses annually for men with a family history of prostate cancer aged 45-69 and in the region of 170 for Black men aged 45-69.
• For these groups, almost 230 men with a family history of prostate cancer per year being spared a stage 4 diagnosis, when prostate cancer becomes incurable. For Black men, 60 avoided stage 4 diagnoses.
• Up to £14,000 net socio-economic benefit for every high-risk man diagnosed.
This would be achieved using current technologies and pathways, and by targeting men from high-risk groups: Black men and those with a family history of prostate cancer (including those with BRCA1/2 mutations).Here are the headline figures noted in their newsletter:
The report concludes that with the introduction of an effective 'reflex test' between a PSA and MRI in the critical pathway, a universal screening programme for men aged 50-69 could save lives and benefit the country economically. This would also move the UK from being one of the worst OECD performers on prostate cancer to being one of the best.
PCR are taking their report forward and meeting with Members of Parliament to put the case. It is also interesting to note in a further landmark report presenting evidence for change the three key areas to go forward. See here: https://www.prostate-cancer-research.org.uk/PFYP/
Here they are taken directly from their report:
1. Introduce targeted prostate cancer screening for high-risk groups as soon as possible
Right now, we need to optimise screening using a PSA test, focusing on high-risk groups – Black men, those with a family history, and those with a BRCA1 or BRCA2 mutation. This approach, prioritising those at highest risk of prostate cancer, has been shown in our report to provide economic benefits, while requiring the lowest level of health system change.
2. Trial new diagnostic tests in clinical practice
Alongside more targeted PSA testing, we need to focus on getting new diagnostic technologies into trial (e.g. reflex tests), to gather real-world evidence and understand the benefit in diverse populations. Once the value of this has been demonstrated, we should expand the screening programme to cover the general population using a test with greater accuracy, as this will realise the greatest economic benefits.
3. Adopt AI-driven tech to enhance patient outcomes and efficiencies
To further improve patient outcomes and the economic benefits of earlier detection, we need to integrate AI technology into the NHS. We need to leverage its potential to improve the accuracy and reliability of screening, avoiding the need for unnecessary biopsies, while also boosting operational efficiencies. By adopting AI-driven technologies in imaging, we can streamline processes, reduce diagnostic errors and ensure resources are allocated more effectively.
Right now, we need to optimise screening using a PSA test, focusing on high-risk groups – Black men, those with a family history, and those with a BRCA1 or BRCA2 mutation. This approach, prioritising those at highest risk of prostate cancer, has been shown in our report to provide economic benefits, while requiring the lowest level of health system change.
2. Trial new diagnostic tests in clinical practice
Alongside more targeted PSA testing, we need to focus on getting new diagnostic technologies into trial (e.g. reflex tests), to gather real-world evidence and understand the benefit in diverse populations. Once the value of this has been demonstrated, we should expand the screening programme to cover the general population using a test with greater accuracy, as this will realise the greatest economic benefits.
3. Adopt AI-driven tech to enhance patient outcomes and efficiencies
To further improve patient outcomes and the economic benefits of earlier detection, we need to integrate AI technology into the NHS. We need to leverage its potential to improve the accuracy and reliability of screening, avoiding the need for unnecessary biopsies, while also boosting operational efficiencies. By adopting AI-driven technologies in imaging, we can streamline processes, reduce diagnostic errors and ensure resources are allocated more effectively.
Thank you PCR!
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