12 February 2021
Prostagram to screen for prostate cancer a step closer
British scientists develop a new scan for prostate cancer – ‘Prostagram’ brings vital mass screening for men ‘a step closer’
Scientists at Imperial College London have developed a new fast scan, or Prostagram, for the early detection of prostate cancer potentially saving thousands of lives per year. This 15-minute scan offers fresh hope for men reluctant to be tested for prostate cancer due to the intrusive nature of current examination techniques.
A Prostagram can be done on any good quality MRI scanner. This is the scanner at Cromwell Hospital.
Prostagram could find an extra 40,000 cases of prostate cancer a year according to a landmark trial, involving 408 men, published today (11th February 2021) in the prestigious journal JAMA Oncology. It is the first time that any scan has been accurate enough to be considered for use as a prostate cancer screening test.
The short, non-invasive procedure, using innovative resonance imaging (MRI) techniques, is modelled on breast cancer screening where women are routinely offered a mammogram scan every three years as part of a national programme, which is credited with saving some 1,300 lives a year, reducing the death toll by more than 10 per cent.
Professor Hashim Ahmed, Senior Author and Chair of Urology at Imperial College London explains “Prostagram has the potential to form the basis of a fast, mobile national screening programme for prostate cancer and could be a game-changer. Prostagram also has the potential to detect more aggressive cancers earlier and pass over the many cancers which don’t need to be diagnosed. By finding these aggressive cancers at the earliest opportunity, men have the opportunity to be offered less invasive treatments with fewer side effects”
At present, some 12,000 men die each year from prostate cancer – compared to around 11,000 for breast cancer – and over the course of the last decade the number of deaths has overtaken that of breast cancer. Creating a national screening programme for prostate cancer could make a major difference in reducing the number of men dying from this disease.
Dr David Eldred-Evans, fellow researcher and developer of the Prostagram said: “The encouraging results of this research study bring a mass screening programme for prostate cancer, equivalent to mammogram testing for women, a step closer”.
He adds “A major achievement for the trial was the recruitment of ethnic minority and lower socio-economic participants broadly equivalent to their proportion within the community, which could be replicated in future general population screening trials. Plans for a more extensive trial covering 20,000 men are well advanced and will proceed in the coming months subject to funding. If results from this study are similar or better than those revealed today, there is then a clear pathway to the widespread implementation of Prostagram into the general population.
If you would like to donate to the Prostagram research programme, please get in touch with Professor Ahmed or follow this link to do so.
Researchers offered the new scan to 408 men in the UK and showed that it picked up twice as many prostate cancers compared to the standard PSA (prostate specific antigen) blood test. Importantly the study was able to enrol 132 (32.4%) black men who are at increased risk of prostate cancer.
The study completed recruitment 19 months ahead of schedule, and received widespread support from well-known personalities including the actor Stephen Fry and community leaders across London.
Background and Context
1. Prostate cancer is a condition which affects one in eight men during their lifetime and one in four black men. There are more than 49,000 cases per year and it is now the most common diagnosed cancer in the UK. Crucially, the study suggests that a Prostagram might offer timelier detection of the more aggressive cancers compared to the PSA blood test. PSA is known to lead to over-diagnosis of unimportant cancers – unlikely to harm those affected during their lifetime – and, as a consequence, provoke unnecessary medical interventions with unpleasant side-effects including urine leak or erectile dysfunction.
2. For the first time the number of men dying from prostate cancer has surpassed breast cancer and a successful screening programme could significantly improve life expectancy for some 12,000 UK men who die each year from aggressive prostate cancer
While breast cancer screening is routinely offered to women from 50 years, there is no equivalent screening programme for prostate cancer. This is because the current PSA blood test used in the community has been shown routinely to miss aggressive life-threatening cancers. About 15% of men with aggressive prostate cancer can still have a normal PSA level. As a result, screening for prostate cancer using PSA blood tests is not recommended in any country.
3. Prostagram uses magnetic waves that have no radiation risk to produce a detailed picture of the prostate making it safe as well as non-invasive. It is a simple, non-invasive MRI scan which lasts around 15 minutes. It is a simplified version of a longer type of MRI which has recently been recommended by the National Institute for Health and Care (NICE) for use in men already referred to hospital by their general practitioner (GP).
4. The Imperial Prostate Prostagram study recruited 408 volunteers aged 50 to 69 years who were screened for prostate cancer applying both a PSA test and a Prostagram. The Prostagrams were reported by doctors before the results of the PSA test to allow a fair comparison of the tests. If either test was suspicious for prostate cancer the men underwent a prostate biopsy which took samples of tissue from the prostate to check whether there was cancer. This allowed the study team to check the accuracy of each test.
5. The researchers found that a Prostagram was more accurate than PSA at detecting aggressive prostate cancer. In total 4% of volunteers had aggressive prostate cancer of which around 75% were identified by Prostagram and only 41% by PSA. The researchers recommended that a larger study recruiting thousands of men was needed to change national screening guidelines.
Additional notes
1. The Study and Publication in JAMA Oncology on 11th February 2021
Title: Population-based prostate cancer screening with Magnetic Resonance or Ultrasound Imaging: The IP1-PROSTAGRAM study
Authors: Eldred-Evans D, Burak P, Connor M, Day E, Evans M, Fiorentino F, Gammon M, Hosking-Jervis F, Klimowska- Nassar N, McGuire W, Padhani AR, Price D, Prevost T, Sokhi H, Tam H, Winkler H, Ahmed HU
2. Funders
The research was funded by the Welcome Trust, The Urology Foundation, the BMA foundation for Medical Research, the Royal College of Surgeons and National Institute of Health Research Imperial Biomedical Research Centre (NIHR Imperial BRC). The MRI scans were performed at Imperial College Clinical Imaging Facility and Paul Strickland Scanner Centre and the biopsies and further clinical management of patients was carried out at Imperial College Healthcare NHS Trust.
3. Institutions
Imperial College London is a world top ten university with an international reputation for excellence in teaching and research. Consistently rated amongst the world’s best universities, Imperial is committed to developing the next generation of researchers, scientists and academics through collaboration across disciplines. Located in the heart of London, Imperial College is a multidisciplinary space for education, research, translation and commercialisation, harnessing science and innovation to tackle global challenges.
Imperial Prostate is a world-leading team of researcher-practitioners who work towards improving the lives of men who develop or are being investigated for prostate cancer and other prostate diseases. The group’s mission is to improve the speed, accuracy and safety of prostate disease diagnosis, and to evaluate new treatments which have fewer side effects than standard techniques without losing treatment efficacy. It is partnered with scientists at Imperial College, who help us develop our research based on the latest scientific discoveries, techniques and technology.
Imperial College Healthcare NHS Trust is one of the largest hospital Trusts in England, providing acute and specialist healthcare for a population of nearly two million people. The Trust has five hospitals – Charing Cross, Hammersmith, Queen Charlotte’s & Chelsea, St Mary’s and The Western Eye – as well as community services.
Wellcome Trust is a global charitable foundation dedicated to achieving extraordinary improvements in human and animal health. The Trust supports biomedical research and the medical humanities. Its breadth of support includes public engagement, education and the application of research to improve health. The Trust is independent of both political and commercial interests.
The Urology Foundation (TUF) is the only UK charity dedicated to all urology diseases and its goal is to put an end to the suffering and deaths that these diseases cause. TUF is administered by a Board of Trustees which includes urologists and lay people.
The BMA Foundation for Medical Research is a charity funded by legacies and donations left to the Foundation by generous individuals. The foundation awards funds to encourage and further medical research across a range of medical research areas.
The Royal College of Surgeons of England is an independent professional body and registered charity that promotes and advances standards of surgical care for patients and regulates surgery and dentistry in England and Wales. The College safeguards experience, treatment and outcomes of the UK’s surgical patients through ongoing state of the art training of surgeons and pioneering research.
NIHR Imperial Biomedical Research Centre (BRC) is a translational research partnership between Imperial College London and Imperial College Healthcare NHS Trust. It provides the infrastructure to conduct early-stage experimental medicine and aims to exploit the scientific power of Imperial College’s Faculties of Medicine, Engineering and Natural Sciences, and provide proof-of-principle of new breakthroughs within the clinical setting.
Paul Strickland Scanner Centre is a specialist medical imaging centre working as an independent charity to improve the lives of people affected by cancer and other serious conditions. The centre’s team provides the best possible patient care using high quality imaging equipment, and by being actively involved in medical research.
If you would like to donate to the Prostagram research programme, please get in touch with Professor Ahmed or follow this link to do so.
Men who are concerned about prostate cancer should in the first instance discuss this with their family doctor (GP). Queries from patients and GPs can also be forwarded to imperial.prostate@nhs.net but GP referrals will be needed for those men who meet the referral criteria set by NICE (UK) for prostate cancer. The following website has further information: www.imperialprostate.org.uk
For NHS referrals, Professor Ahmed works at Imperial College Healthcare NHS Trust. You are entitled to ask for a referral to Imperial if you meet the UK government criteria for further investigation for prostate cancer on the NHS. Your GP can make the referral through the choose and book electronic referral system and choose the ‘2WW – prostate’ folder. You consultant team can also make the referral directly to Imperial using the email: imperial.prostate@nhs.net or letter (addressed to Professor Ahmed at Charing Cross Hospital, Fulham Palace Road, London W6 8RF).
For private referrals, Professor Ahmed works at Cromwell Hospital and Imperial Private Healthcare. Self-pay patients do not need a referral to consult Professor Ahmed and there are competitive self-pay packages offered. Insured patients should check with their insurer.
Please use the online booking portal or email the team on london.prostate@gmail.com