London, 24 Aug — New research conducted by UCL, UCLH, and King’s College London reveals a breakthrough in prostate cancer detection. By combining MRI scans with PSA density testing, cancers that might have been overlooked by traditional blood tests alone were successfully identified.
Published in BMJ Oncology, the REIMAGINE study pioneers the use of MRI scans alongside prostate-specific antigen (PSA) density to evaluate the necessity of additional standard NHS tests. Remarkably, out of the 29 participants diagnosed with severe prostate cancer, 15 had a 'low' PSA score, which typically wouldn't prompt further investigation under the current protocols.
The accuracy of cancer diagnosis significantly improved with MRI scans compared to blood tests that assess elevated levels of PSA. MRI uncovered certain critical cancers that might have escaped detection through PSA alone. Presently, there's no nationwide screening program due to the unreliability of PSA, although men over 50 can request the test. The researchers propose the potential utilization of prostate MRI for screening, acknowledging that a larger study would be essential to validate this approach. While earlier research demonstrated a 20% reduction in prostate cancer mortality after 16 years with a combination of PSA testing, digital rectal examination, and subsequent biopsy if needed, this approach has been associated with both overdiagnosis and overtreatment of less aggressive cancers.
In recent times, introducing MRI as the initial step in evaluating men at higher risk for prostate cancer has spared one in four men from unnecessary, invasive biopsies that may lead to complications. By integrating MRI as a proactive screening tool offered without specific requests, the aim is to further diminish prostate cancer mortality and unwarranted treatment.
This groundbreaking study not only revolutionizes prostate cancer detection but also heralds hope for reducing mortality rates and unwarranted treatments. The introduction of MRI as a viable screening method, particularly if made more accessible, signifies a significant victory in humanity's ongoing fight against prostate cancer, promising both enhanced accuracy and a more informed approach to treatment decisions.
Source: Moore CM, Frangou E, McCartan N on behalf of the Re-Imagine Study group, et al "Prevalence of MRI lesions in men responding to a GP-led invitation for a prostate health check: a prospective cohort study" BMJ Oncology 2023;2:e000057. doi: 10.1136/bmjonc-2023-000057
UCLH. "MRI scans improve prostate cancer diagnosis in screening trial". https://www.uclh.nhs.uk/news/mri-scans-improve-prostate-cancer-diagnosis-screening-trial. 22 August 2023. [Accessed: 24 Aug 2023].
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