Prostate cancer diagnosis and the treatment pathway is developing all the time, and globally, there has been a shift in how scientists and clinicians are viewing the PSA test for symptomless men. This Report from Prostate Cancer UK highlights The European Commission call for prostate cancer screening in men up to 70 on the basis of PSA testing, with magnetic resonance imaging (MRI) scanning employed as the follow-up if required.
The PSA blood test is the first step towards a diagnosis. It isn’t accurate enough to tell for certain if a man has prostate cancer or not. This means men need further tests, including a biopsy to confirm whether they have the disease.
It is believed the current diagnostic pathway, including mpMRI, targeted biopsy and transperineal biopsy, has reduced the harms of over-diagnosis, with evidence showing that over-treatment rates have also reduced with active surveillance chosen more consistently by men with low and low/intermediate risk localised prostate cancer.
Image copyright Prostate Cancer UK
Two new techniques have been crucial to the new diagnostic pathway – multi parametric MRI scans (mpMRI) and transperineal guided biopsy (the needle is inserted into the perineum rather than the rectum, giving a lower risk of infection).
Before 2019, men with a high level of PSA in their blood were sent straight for a biopsy, which could cause pain and bleeding, and came with a risk of serious infection. These biopsies could also sometimes miss the cancer, leading to repeated biopsies with further risks of infection and uncomfortable side-effects.
Having a mpMRI scans beforehand could safely rule out many of these biopsies as unnecessary, as well as improving the accuracy of those that were needed, making them more likely to detect the cancer the first time.
Our Trustee and Professor and Clinical Director of Urology at the Royal Surrey, Stephen Langley said that the Stokes Centre is leading the way in this screening, with NHS England showing their confidence and support to the tune of £500,000 funding.
Talk Prostate is a pilot scheme being run in a partnership between the Surrey and Sussex NHS Cancer Alliance (SSCA) and virtual NHS healthcare provider, Medefer. To date 500 at risk men have been invited for a PSA test, and the plan is for over 24,000 PSA tests to be conducted over the next two years in the Surrey and Sussex region.
Men will also be able to self refer via the Talk Prostate website. The ‘Man Van’ is the next stage in this scheme, giving men more opportunities and options of when and where to get their test, as well as providing drop-in opportunities, another reason why the team can’t wait to get the van on the road!